ACA FAQs Regarding Participating vs. Non-Participating Medicare Status
ACA receives a multitude of questions regarding Medicare and the physician fee schedule. Following are answers to some of the most frequently asked questions:
Q: Can I just ignore the fee schedule? I’m non-participating anyway.
Q: Who do I contact for the latest information on the fee schedule? It's always so confusing at the end of the year.
Q: Could you provide a complete explanation of par fee allowance, non-par fee allowance and limiting charge?
Q: Can I change my Medicare Participating status?
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Patients' Complaints to the PA Insurance Department (PID)
PCA members should be prepared to give their patients instructions and forms for filing complaints with the Insurance Department (link to PID patient complaint form, click here). When patients are expected to be financially responsible for services that may be denied by health insurers and/or their intermediaries, they will most certainly want to complain to someone. PCA President Raymond Benedetto, DC, commented, “The PA Insurance Department has clearly requested PCA to direct patients and their complaints to the PA Insurance Department, so that’s what PCA members should do. Our members are currently serving as the voice for many of their patients, so it is extremely important that members direct their patients to the PA Department of Insurance.”
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PA Department of Human Services
US Department of Health and Human Services
Bureau of Workers' Compensation
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Health Insurance Exchange
Health Insurance Resources
Aetna's Health Care Professionals Resources
Click Here to access Aetna's Health Care Professionals Resources page. You may have to login to access certain parts of this website.
Click Here to login to NaviNet to access Aetna's Fee Schedule.
Centers for Medicare & Medicaid Services
Click here to go to CMS website.
Click Here to access Medicare Part B Fee Schedule
Cigna's Resources for Health Care Professionals
Click Here to access Cigna's Resource page for Health Care Professionals. You may need to login to access certain parts of this website.
Highmark's Provider Resource Center
In order to get to the Provider Resource Center (PRC), you must CLICK HERE first. Once Highmark’s homepage is open, you will then find the PRC link, and many other helpful links, under the Helpful Links category. Highmark may require login information to access certain parts of this website.
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