As communicated in our November newsletter, the state of Minnesota received federal approval to expand its chiropractic benefit to include one annual exam beginning on January 1, 2011. Along with the expanded benefit, the state has also implemented authorization requirements which are applicable to all chiropractors, regardless of ChiroCare's assigned category.
ChiroCare business affected by this change includes most HealthPartners and UCare Medicaid programs.
Below are the details regarding the state's coverage of exams:
- The expanded benefit is only applicable for patients with coverage through state public programs/Medicaid. Please note that some members who have dual eligibility (through both Medicare and Medicaid) however, are not eligible for coverage of the exam through the state benefit. As such, it will be important to verify benefits using the resources outlined on the applicable Plan Summary to protect yourself from unexpected claim denials.
- Patient coverage is limited to one covered exam per calendar year.
- Per the state, covered exams include only the following codes:
|
99201 |
99211 |
|
99202 |
99212 |
|
99203 |
99213 |
Other exam codes billed for this population will be denied.
- The standard rules for exams will be applied when determining payment eligibility, e.g. initial exams are allowed only when treating a new patient, or after a three-year break in care for patients previously treated.
- All billed exams must be medically necessary and not related to wellness care.
In conjunction with the expanded benefit, the state is requiring all chiropractic providers to obtain PRIOR authorization for any care rendered to a Medicaid patient beyond 12 chiropractic visits in a calendar year. Per the state, retroactive reviews can not be done in these cases. This state requirement applies to all chiropractors, including ChiroCare's Category A providers, and includes all chiropractic care rendered, even if split between multiple chiropractic providers. Please confirm whether or not your Medicaid patients have received other chiropractic care within the same calendar year when determining if prior authorization is required.
We are currently adjusting our online system to accept electronic authorization requests from Category A providers and anticipate completion in early March. Until then, Category A providers who have a Medicaid patient requiring more than 12 visits in the calendar year must submit a hard copy Chiropractic Treatment Plan Form to obtain prior authorization. This form can be found in the Forms/Utilization Management Section on the Admin Resources tab of ChiroCare Connect.
Additional information and resources:
- To review ChiroCare's updated (2011) Plan Summary and Fee Schedules, go to the Plan Summaries, Fee Schedules and Contract Documents Section on the Admin Resources tab of ChiroCare Connect.
- To obtain a Chiropractic Treatment Plan Form, go to the Forms/Utilization Management Section on the Admin Resources tab of ChiroCare Connect.
- To review the state statute regarding this benefit change and unique authorization requirements, please click here and scroll down to Subd.8e. Chiropractic services.
- To review the updated Chiropractic Services section of the Department of Human Services' MHCP Provider Manual, click here.
Please contact our Provider Services team at (888) 638-7719 if you have any questions about this expanded Medicaid benefit or the state's authorization requirements.
Sincerely,
Tabatha Erck
Chief Executive Officer
