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The American Chiropractic Association’s (ACA) Insurance Relations Department advocates for fair coverage and payment policies for the chiropractic profession. The Department maintains an ongoing line of communication with a variety of insurers as a way to work through chiropractic-related insurance problems and to improve the communication between the profession and insurance industry. As well as monitoring state and nationwide insurance challenges, Insurance Relations responds to numerous requests for assistance from individual doctors of chiropractic.
ACA has created the Chiropractic Networks Action Center to provide an area where providers and patients can make their concerns heard. It is also the place where providers can access helpful resources, speak up on behalf of doctors of chiropractic, and read about ACA's efforts to combat inappropriate network practices. Some of these efforts include: ACA’s recent joining of a class action lawsuit against UnitedHealthcare/Optum, a call to action regarding America Specialty Health Network, and much more.
Aetna UCR Lawsuit Settlement
Recently, Aetna agreed to settle a class action lawsuit in the amount of up to $120 million (gross amount). Plaintiffs of the class (consisting of Aetna subscribers and providers including doctors of chiropractic) alleged that Aetna utilized improper methods and reimbursement databases when calculating payment for services performed by out of network providers. Members of the class who are interested in submitting a claim for their pro rata share of the up to $120 million settlement are encouraged to do so prior to the March 28, 2014 deadline. To determine your eligibility and to obtain further information on submitting a claim, please click here. Frequently asked questions and claim forms can be found at http://aetnaucrsettlement.com/home.html
This code conversion tool simplifies the conversion of diagnosis codes from ICD-9 to ICD-10 and includes over 150 codes commonly used in chiropractic clinics. Developed in coordination with the American Academy of Professional Coders (AAPC), it uses a three-step mapping process to assure accuracy and provides additional helpful code selections and instructional notes. Unlike typical code translators, the Mapping Tool does not simply take the user to the General Equivalence Mappings where the remaining detail must be looked up in the ICD-10 manual. With the exception of a few codes, this Tool guides you to the full detailed mapping in order to help your clinic in the transition to ICD-10, and minimizes staff time in searching for the ICD-10 equivalent for commonly used codes. Be sure to log in with your member username and password to receive the significant member discount.
Aetna Update: New Claims and Appeals Resources
ACA has been regularly updating members on its progress with Aetna regarding the processing of claims containing 97140-59 and CMT. Our most recent release stated that Aetna agreed to pay for 97140 when billed with CMT, if provided to a separate spinal region, and documentation for medical necessity was submitted with the claim. To assist members with filing these claims and appealing wrongful denials, ACA has created a new webpage.
NUCC Updates 1500 Claim Form
On June 17 , the National Uniform Claim Committee (NUCC) announced final approval of the Version 02/12 1500 Claim Form by the Office of Management and Budget. NUCC began revisions of the 1500 claim form in 2009 in order to accommodate reporting needs for ICD-10 and Version 5010. ACA has compiled additional information to help you better understand the change and to assist you in the transition.
Accountable Care Organizations
A new resource, “Accountable Care Organizations – What’s Next for DCs,” is now available to members who are interested in learning more about ACOs and how to affiliate with them. We encourage you to review this information and contact us with any questions and/or information you may have about ACOs being established in your state. ACA is also developing additional resources on this topic and will announce their availability via Week in Review in the near future.
Transition to ICD-10 is underway with implementation possibly as early as 10/1/2015. We await final decision from CMS at this time. In the meantime, ACA has created resources to help members with the transition for compliance with both HIPAA Version 5010 and ICD-10, which include articles, timelines, FAQs, and links to outside resources. These resources on the ACA’s ICD-10 web page will be continuously updated as new information is released from government sites. Also, check your quarterly In-Touch e-newsletter for in-depth articles and resources.
Boy Scouts of America
ACA has been advocating for doctors of chiropractic to be able to perform annual evaluations on Scouts and Leaders since early 2009 when a change was made disallowing DCs from provision of these services. Additionally, ACA has created tools to help doctors, patients and members of the Scouting community voice opposition to this policy.