Chiropractic has the strangest payer landscape of any provider type we credential. Medicare covers exactly one thing. Half the commercial business is administered by a network manager rather than the plan. And for many practices the real revenue is personal injury and workers compensation, which are not credentialing at all. They are a different set-up entirely.
Our chiropractic credentialing services deal with all four. Ask any chiropractor credentialing service the same question we answer below, which of these networks is worth joining in your market, and we will tell you which of them are worth your time in your market.
Medicare covers manual manipulation of the spine, and nothing else
This surprises nearly every DC we enroll
Medicare covers chiropractic services only for manual manipulation of the spine to correct a subluxation. CPT 98940, 98941 and 98942, with the AT modifier to indicate active treatment. Exams, x-rays, therapies and modalities performed by a chiropractor are statutorily excluded, whoever performs them.
You still have to enroll. Medicare requires participating and non-participating chiropractors to be enrolled to bill at all, and a patient cannot simply be billed privately for a covered service without the right advance notice.
- Enroll through PECOS on the CMS-855I, with a group CMS-855B if you bill under a practice entity.
- Use the AT modifier for active treatment; maintenance care is not covered and should be handled with an ABN.
- An ABN (Advance Beneficiary Notice) is how you legally bill the patient for maintenance care and for the excluded services. Getting the ABN process right is worth more to most chiropractic practices than the Medicare fee schedule itself.
You are often applying to a network, not the plan
As with physical therapy, a large share of commercial chiropractic business runs through a specialist network manager. An application sent to the health plan is simply not processed.
| Network manager | Typically handles |
|---|---|
| American Specialty Health (ASH) | Chiropractic and PT networks for many commercial and Medicare Advantage plans |
| Optum Physical Health | Chiropractic, PT and OT for several large carriers |
| The plan direct | Some regional BCBS plans and most Medicaid programs |
These networks also tend to apply their own utilization management, visit caps, treatment plan review, and medical necessity documentation standards that are stricter than the plan's. We tell you what you are signing up to before you sign.
Personal injury and workers compensation
For a lot of chiropractic practices this is the majority of collections, and it is not a credentialing process:
- Personal injury is generally billed against an auto policy's medical payments coverage or a third-party liability claim, often on a letter of protection. There is no network to join. What matters is documentation, lien paperwork and the relationship with the attorney. See personal injury billing.
- Workers compensation is state-regulated, pays from a state fee schedule, and often requires you to be on an employer's or carrier's approved provider panel. That panel enrollment is something we file. See workers compensation billing.
A practice that is strong in PI and workers comp may rationally join very few commercial networks. We will say so if that is what the numbers show.
What is included
- CAQH ProView built, populated and re-attested every 120 days.
- NPI type 1 and type 2 with chiropractic taxonomy.
- Medicare enrollment through PECOS, plus revalidation.
- Network manager applications to ASH and Optum Physical Health where they own the product.
- Commercial and Medicaid applications filed direct where that is the route.
- Workers compensation panel enrollment in your state.
- Fee schedule and utilization review before you sign, visit caps included.
- Weekly follow-up and a written status report per application.
How long it takes
| Application | Typical time to effective date | What slows it down |
|---|---|---|
| Medicare | 45 to 90 days | PECOS validation; specialty code selection |
| ASH or Optum Physical Health | 60 to 120 days | Application sent to the plan instead of the manager |
| Commercial direct | 90 to 120 days | Closed chiropractic panels in saturated metros |
| Medicaid | 60 to 120 days | Chiropractic is an optional benefit and excluded in some states |
| Workers comp panel | 30 to 60 days | State-specific forms and fee schedule acknowledgements |
Document checklist
- State chiropractic license, and any additional state licenses
- NPI confirmation letters, type 1 and type 2, with chiropractic taxonomy
- Malpractice certificate showing limits and dates
- CV with month and year dates and an explanation of any gap over 30 days
- Chiropractic college diploma and NBCE board results
- X-ray or radiology supervision permit where your state issues one
- W-9 in the exact legal name on the tax ID
- Practice locations, including any satellite offices
- Current fee schedule and most-billed CPT codes
Pricing
Quoted per provider, per payer, with workers comp panel enrollment priced separately because it is state-specific work. Ask for a quote and you will have it in writing before anything is filed.
Credentialing and billing together
- Claims sidechiropractic billing services 98940 to 98943, AT modifier, ABNs and visit-cap tracking.
- Shared networksphysical therapy credentialing, since ASH and Optum run both.
Chiropractic credentialing FAQs
Do chiropractors have to enroll with Medicare?
If you want to treat Medicare beneficiaries, yes, even to bill the patient correctly for non-covered care you need to be enrolled and to use the ABN process properly. Chiropractors cannot opt out of Medicare the way some other provider types can.
What does Medicare actually pay a chiropractor for?
Manual manipulation of the spine to correct a subluxation: CPT 98940, 98941 and 98942 with the AT modifier for active treatment. Exams, x-rays, modalities and therapies are excluded when performed by a chiropractor.
Why do I have to apply to ASH instead of the insurance company?
Because for that product the carrier has delegated its chiropractic network to American Specialty Health. The credentialing, the contract, the fee schedule and the utilization review all sit with ASH. Applications sent to the plan are not forwarded.
Do I need credentialing for personal injury work?
No. PI is billed against an auto policy or a liability claim and there is no network to join. Workers compensation is different, many states and carriers run approved provider panels, and that enrollment we do file for you.
Is it worth joining commercial chiropractic networks at all?
Sometimes not. Chiropractic contracts frequently carry low rates and hard visit caps, and a practice with strong PI and cash volume can do better outside them. We model it against your actual case mix rather than assuming more networks is better.
Free credentialing check
Tell us your state and your case mix, commercial, Medicare, PI, workers comp. We will tell you which networks are worth joining and which will cost you more in write-offs than they bring in.
Free credentialing check Talk to a credentialing specialist