Can provider bill patient for mised appointment


*  Missed appointments by the member must be followed-up by the Provider.

The CarePlus Member Services Department will assist the Provider in this process if necessary. If the
patient does not go to the previously scheduled appointment without prior cancellation, Provider must
document within the medical records. A Provider may charge a fee for missed appointments, provided such fees apply uniformly and at the same amount for all Medicare and non-Medicare patients.


To ensure accessibility and availability of health services to plan members, the following standards have been set forth by the Centers for Medicare & Medicaid Services (CMS):

-  Urgently needed services or Emergency – immediately.
* Non-urgent, but in need of attention – within one (1) week.
*  Routine and Preventive Care – within 30 days. Non-emergent complaints that do not restrict a
member’s activity or are chronic in nature.
* Provider agrees to maintain hours that do not discriminate against Members’ accessibility to


Upon enrollment, CarePlus will send the member an Acknowledgement of Enrollment Letter, which will also include the member’s Evidence of Coverage (EOC) and Member Identification (ID) Card. The EOC educates the patient on the following subjects:
-How to schedule an appointment;
-What to do in case of an Emergency;
-How to contact their PCP during and after business hours; and
-How to access “out-of-area services”.
Each Plan Member will be identified as follows:

Each Plan member will be identified by a CarePlus member ID card which indicates assignment to a
specific PCP and co-payment guidelines. All CarePlus Plan Members are sent an ID card which will be presented at the time of each visit. When membership eligibility cannot be determined, you may contact the Provider Services Queue for “Eligibility Verification” at 1-866-313-7587, Monday through Friday from 8:00 a.m. to 5:00 p.m.

Please note that possession of a card does not constitute eligibility for coverage. Therefore, it is
important that physicians/providers always verify a Member’s eligibility each time the Member presents at the office for services. New members may use a copy of their enrollment application as proof of enrollment. If a CarePlus member is unable to present his/her membership card, please call the Provider Services Queue to determine eligibility.

Verifying eligibility does not guarantee that the patient is in fact eligible at the time the services are
rendered or that payment will be issued. We provide our members several options of health plans with an array of services, deductibles and co-payments. Payments will be made for the specific covered services provided to eligible CarePlus members after satisfaction of applicable premiums and copayments.

1 comment:

Tara Claims said...

I can't believe that is actually legal!

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