News from the NIC - Summer 2022

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.

Workers' Compensation

The required submission of CMS-1500 Forms and Supportive Documentation is finally here. July 1st marks the first date of this requirement. The NYSCA would like to thank all of you who attended our workshops as well as the NYS Workers' Compensation Board (WCB) for their ongoing support and numerous presentations. We understand there is still a steep learning curve for many of you as you continue to make this transition. The NYSCA will continue to provide updates and assistance, particularly as we hear for you, our members. The following announcement was received today from the NYS WCB:

Providers: Use of the CMS-1500 Form is Mandatory Starting Today

Use of the CMS-1500 form is mandatory starting today.

You can read more about the requirements and form changes in the GovDelivery dated June 27, 2022.

Please be reminded that health care providers must include in the medical narrative attachment the injured worker’s temporary impairment percentage, work status, and the causal relationship of the injury either at the top of, or prominently displayed on the medical narrative that accompanies the CMS-1500 form.

If any of these elements are missing, the medical narrative report may be found legally defective, which means you may not be paid for rendered services.

Additional Resources

Visit the Workers' Compensation Board’s (Board's) website for CMS-1500 news, FAQs, and more. The Board has also created a special webpage dedicated to sharing timely updates on various Board initiatives with a health care provider focus. Visit What Providers Need to Know to view the latest!

For CMS-1500 feedback and questions, email [email protected]. For clinical feedback and questions, email [email protected].


The NYSCA Insurance Committee reached out to MVP to define which insureds require prior authorization by eviCore. This new requirement which went into effect March 1st only applies to select MVP enrollees; however, it remained unclear as to which insureds (patients) required authorization. MVP has been quite responsive and has obtained the following information from eviCore:

For New York commercial plans in general, only the HMO and POS plans are in-scope for eviCore chiropractic prior authorization. The EPO, PPO, and indemnity plans are out-of-scope.

We understand that you may have received conflicting information from eviCore in the past; however, the above guidance may prove helpful to you. As always, it is prudent to document your calls (time & date, representative's name and reference number) and electronic interactions with insurance carriers to assist in the event of a payment denial.

More exciting news: MVP will now directly contract with doctors of chiropractic! By now many of you have received an invitation, documentation and instructions from MVP. Updated fee schedules have been included. Although the effective date is January 1, please note that initial contracting and credentialing often requires many months for the health plan to complete. Insurance carriers like MVP also depend upon other organizations (such as CAQH, state licensing boards, and malpractice carrier) to communicate with them in a timely and effective manner. In addition, health plans typically review their existing networks and prepare information and directories months in advance to ensure they are providing the most accurate information to their members. We understand that your offices have been busy preparing for the July 1 workers' compensation changes; however, please note that MVP has requested your response by July 1.

Many of you have contacted the NIC with questions regarding the new program. Perhaps the two most commonly asked questions awaiting clarification involve the definition of an initial visit in the fee schedule, and further details on the Medicare Advantage product. The NIC has reached out to MVP regarding these and other questions and are awaiting a response from them. We recognize that the answers to these questions will assist you in making the most informed decision. We look forward to sharing additional information with you as we receive it.

Please do not forget: you may also seek answers to your questions directly from MVP at [email protected]. Note that this is the same email you will use to email the completed documentation to MVP. 

Highmark BCBS Western NY

To provide some background information, the following is from

In March of 2021, Highmark Inc. announced the completion of its affiliation with HealthNow New York Inc. The newly affiliated organization was rebranded Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York and serves members in 21 counties in northeastern and western New York. The affiliation brought Highmark health plan membership to more than 6 million people — making it the fourth largest Blue Plan in the nation.

The NIC reached out to Highmark of Western NY to assist our members in better understanding Highmark requirements, and to obtain assistance in resolving communication, eligibility, claims submission and processing issues. Special thanks to provider account liaison Luis Rodriguez of Highmark Western NY, who acknowledged our member concerns and reviewed the changes that are occurring as a result of the above-referenced affiliation. Patients in the legacy BlueCross BlueShield of Western NY system are being migrated throughout 2022 to the Highmark system. This includes claims processing.

Mr. Rodriguez noted that various online tools have been created to assist providers, including: Working Together During the Highmark Affiliation

The NIC briefly reviewed the information provided at the above link, which contained helpful information to identify which system your patient is in, details of the changes, a recorded webinar link, and a Frequently Asked Questions section which appears to answer many (if not all) of our member's questions. This last section was just updated on 6/24/22.

Highmark has also created a Highmark Provider Resource Center.

Additionally, Mr. Rodriguez noted that Highmark has enhanced their forms and processes for updating providers. There is no longer a paper demographic change form. Please visit their Forms page and be sure to go to their provider website to complete changes online.

Please note that Highmark's provider account liaisons can assist with certain claims processing issues; however, that representative needs a valid claim number to adequately research a particular claim issue.

In Closing

The NIC would like to express our sincere appreciation for your continued support - not only by your NYSCA membership, but by the challenges and successes you share with us on a daily basis. Please continue to update us so we may better assist your colleagues and our profession to excel on behalf of chiropractic patients.

Share your Pearls. TOGETHER WE ARE NYSCA


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