The NYSCA Insurance Committee (The NIC) is bringing you the latest updates on CDPHP.

The NYSCA Insurance Committee (The NIC) is bringing you the latest updates on MVP.

The NYSCA Insurance Committee (The NIC) is requesting your assistance as we compile recent blinded examples of claims which have not been acknowledged or processed and in a timely manner by Cigna.  These are claims which do not involve American Specialty Health (ASH), but are solely the responsibility of Cigna.  Remember: Health Plans subject to the laws of New York are required to acknowledge or process clean claims within 30 or 45 days of receipt.  Failure to do so can result in interest and penalties.

The NYSCA Insurance Committee (the NIC) has been in contact with American Specialties Health (ASH) to better define the benefits available to Wellcare members. Please note that All Wellcare insureds DO NOT have the insurance rider which covers all of the services listed in the ASH G9 fee schedule. NYSCA members have reported a difference in benefits when checking eligibility on ASHLink vs talking to a representative or when performing an ASHLink Inquiry.

Insurance Updates Effective January 1, 2023

2023 brings forth continued positive changes for doctors of chiropractic practicing in New York. Across the state certain health plans have increased fee schedules and enhanced coverage. In addition, a few third-party administrators have been eliminated, and unreasonable utilization review has been discontinued. Reasonable reimbursement and the elimination of administrative burdens affords us more time to assist our patients in achieving their goals. With significant involvement from our members, the NYSCA continues our drive to parity and fairness in reimbursement and administrative practices.

Warm Greetings from the NYSCA Insurance Committee! This summer has brought forth several important changes and deadlines which have impacted how you interface with payers.  The NYSCA Insurance Committee (The NIC) has been inundated with calls, especially with the new Workers' Compensation requirements and the new MVP program effective 1/1/23. This article will address questions related to the New MVP program. Workers’ Compensation will be addressed in a separate piece.

As you prepare for your holiday weekend, the NYSCA Insurance Committee (the NIC) would like to provide you with the following reminders and updates which encompasses three topics: Workers' Compensation, MVP, and Highpoint BlueCross Blue Shield of Western New York. More detailed information and news related to other insurance issues will be disseminated in the next several weeks.

As you may be aware, the No Surprises Act was passed at the end of 2020 as a part of the Consolidated Appropriations Act of 2021. Initially most experts believed this act applied only to facility-based providers. However, the recent finalization of Part II of the rules has a specific portion that applies to all health care providers.

Your office may have received a notice from American Specialty Health (ASH) titled REMOVAL FROM PARTICIPATION FOR SPECIFIC CLIENT SOURCES. The letter indicates that your office has been terminated from participation in Medicare specific Client Summaries as allowed in your ASH Practitioner Services Agreement.

A NYSCA member asks: A patient just called to make an appointment; however, they attended a protest a few days ago. Can I see them if they have not demonstrated Covid-19 symptoms?

The NYSCA Officers thank the insurance committee for their work in continuing this conversation and assisting in bringing more options to New York's chiropractors and chiropractic patients.  Updates to the United HealthCare policies allowing chiropractors to utilize telemedicine services to care for their patients is below.

During the COVID-19 crisis, telemedicine and telehealth services will allow you to continue to care for your patients from a distance.  The NYSCA Insurance Committee continues to interact with various NYS offices, commercial carriers and TPAs to discuss and seek their guidelines relative to the application and coverage of telemedicine services for doctors of chiropractic.

UnitedHealthcare will require the use of a 'GP' modifier for all billed physical medicine services effective 04/01/2020. 

Please note the following notification from American Specialty Health (ASH) relative to employees of Suffolk County.

The following information has been received from Aetna to assist in your transition to the new program.