From the Managed Care & Insurance Committee

The California Chiropractic Association (CalcChiro) Managed Care & Insurance Committee has communicated with Anthem/Blue Cross representatives on the claims adjudication revision that became effective 01-01-18. Anthem/Blue Cross representatives state that providers were notified of this change in claim adjudication through their provider newsletter prior to enactment. Anthem/Blue Cross has continued to evaluate their standards for ensuring provider non-discrimination practices consistent with Section 2706 of the Affordable Care Act. This change in alignment to ensure compliance with the Section includes ensuring benefits are applied based on the “service” provided vs. the provider specialty or licensure. Doctors of chiropractic are receiving EOB’s with multiple deductions on the same date of service. The primary change is the application of the co-insurance amount for several separate procedures performed on the same date of service. CalChiro has reviewed EOB’s from other practitioners that show similar co-insurance deductions, thus substantiating Anthem/Blue Cross’ application of the non-discrimination provision of the Affordable Care Act.

For those self-funded/insured employers whose benefits are administered by Anthem/Blue Cross, the alignment with Section 2706 may not be applied to the claims adjudication process. Each of these entities will make a self-determination on whether to revise their claims adjudication process to comply with Section 2706.

CalChiro recommends verifying the member/patient benefit through the plan’s electronic platform or via telephone to identify how the benefits will be adjudicated along with the deductible, co-payment, and co-insurance amounts for which the member/patient is financially responsible.

CalChiro will monitor, with member assistance the claim adjudication process and to ensure compliance with Section 2706, and other applicable statutes. The Managed Care & Insurance Committee with continue outreach to the regulators of health delivery in California to ensure compliance and to advocate for an improved delivery system that includes non-discrimination towards doctors of chiropractic. CalChiro appreciates the documentation you all have provided to date, and we request you continue to forward EOB’s and other documents you believe will benefit this strategy.

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