[UPDATE] From CalChiro’s Managed Care & Insurance Committee Regarding January 2020 Meeting
January 23, 2020

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The Managed Care & Insurance Committee held its monthly meeting to discuss health plan issues and initiate the scheduling of meetings with stakeholders including legislative staff/consultant members, Surgeon General of California, and health plan representatives. Discussion regarding coalition building to add strength and numbers to issues of concern in 2020 was entertained.

The Governor has created two entities – Health California for All Commission, and the Office of Health Care Affordability. CalChiro representatives will attend meetings and participate in public-policy discussions for both entities. It is anticipated that information hearings on the expansion of the Essential Health Benefits definition will occur in the next several months. It is not yet certain if provider groups will be invited to submit oral testimony, but certainly CalChiro will be available in that regard and certainly will provide written testimony. The expansive definition is important as CalChiro will advocate for the inclusion of doctors of chiropractic as a category of provider – particularly in the Covered California program.

CalChiro has received from members issues related to E/M code use, adjudication of claims of Medi-Cal beneficiaries (particularly in those members whose benefits are managed by a delegated entity), access to doctors of chiropractic by children (typically under 4 years of age), and adjudication of 3rd party liability claims.

As always, documentation received by CalChiro members related to denial of claim submission, or issues that appear discriminatory are welcomed by the association.