In November 2025, the WCA Help Desk was made aware of changes with WPS Health Insurance.
Since this time, they have removed the prior authorization requirement for spinal manipulation; however, medical documentation may be requested after the 8th visit to establish medical necessity.
We were also made aware that patients have been receiving letters regarding past chiropractic services. 

On December 5, the WCA and WPS met to discuss the 2026 policy changes. Read more.

Not a member? Join WCA today to access important Help Desk practice updates. 

The WPS Medical Policy Committee recently met and approved several new medical policies, as well as those due for annual review. Please take a few moments to review the following updates and note the effective date of 12/1/2025.

View Changes Here with your WCA Login >>

It has been brought to the WCA’s attention that Aspirus Health Plan, in the September 2025 provider notification, released changes to the prior authorization list, effective November 1, 2025.
 
What We Know So Far
Added to this list are chiropractic services 98940, 98941, 98942 and 98943. (The prior authorization list and policy can be found here).
 
Providers were advised to review the updated list to prevent denied claims and note that non-urgent PA requests require submission two weeks prior to service. It also states that retrospective authorization requests will only be considered on very limited circumstances. We know that this is not the way chiropractic care works.

Read More Here >>

Each July 1, the Wisconsin Department of Health Services will adjust the dollar amounts that a health care provider may charge for providing paper copies of a patient’s health care records.

There was also a 2023 Wisconsin Supreme Court ruling that drastically changed the Electronic Health Care Records Fees. DCs/Staff will want to access this updated guide to make sure you are being compliant and following the new Electronic Records Law and Paper Requests.

View the Records Fees Guide with your WCA Member Login >>

In a landmark development, Blue Cross Blue Shield (BCBS) has reached a $2.8 billion settlement to resolve antitrust claims brought by health care providers, including chiropractors. 

The lawsuit accused BCBS of dividing the nation into exclusive regions and limiting competition, which resulted in lower reimbursements for providers. Although BCBS denies any wrongdoing, the company agreed to the settlement to avoid lengthy litigation – and you can get a piece of the pie.

Learn More Here >>

Not a member? Access this important information when you join the WCA today!

Chiropractic Future has taken a significant step forward in empowering chiropractic patients by developing and distributing three educational flyers aimed at addressing complex and often restrictive insurance policies.

These resources are designed to help patients better understand and navigate high copayments, per-diem payment models, and prior authorization requirements—common barriers to receiving timely and affordable chiropractic care.

Read More & Download the Patient Flyers >>

Not a WCA Member? Join today and access this important information.

Your Voices Have Been Heard! Thanks to feedback from providers like you, UnitedHealthcare has made important updates to its prior authorization requirements for therapy and chiropractic services under the Medicare Advantage Individual and Group Retiree plans.

Read more to learn what we know...

Since the Supreme Court overturned the right to certain reproductive procedures in 2022, the Federal government has been at odds with some states in allowing access to reproductive healthcare. The Department of Health and Human Services has mandated a new rule within HIPAA privacy regulations that must be implemented in every healthcare provider’s office by December 23, 2024. Knowledge and implementation of the rule is essential, including DC’s.
 
Congress passed the new rule in April 2024, with implementation effective on June 5, 2024.  HHS and the Office of Civil Rights (OCR) delayed enforcement of the rule until December 23, 2024.  The Rule addresses situations in which states that prohibit abortion try to investigate or prosecute their citizens who obtain abortions in other states where abortion is legal. The Rule generally prohibits providers from disclosing protected health information about reproductive healthcare (“RPHI”) for investigative purposes if the reproductive care was legal in the state where it was rendered. 

As health care providers, we are affected by this rule if a third party requests records on an individual where law enforcement may be investigating a patient who underwent the procedure or a provider who performed the procedure. In those cases, the Federal government restricts the release of records and may construe it to be a breach of PHI if the information is released.

Read More >>

August 22, 2024

• View Provider Letter from Optum
• View Provider Letter from Humana
  

Here's what WCA knows so far...

>> United Healthcare-AARP Medicare
This will require online clinical submission of a Patient Summary Form (PSF), for  certain  United Healthcare and AARP Medicare Advantage members. A PSF is not required for the initial evaluation. A PSF submission is required for subsequent visits. This will include treatment in progress after the effective date. This change will be required for all in-network DC providers, no matter your Tier status with Commercial United Healthcare plans.

• Online clinical submissions can be completed at myoptumhealthphysicalhealth.com.

Resources that Can Help with this Change
The WCA Help Desk has reviewed  optumhealthphysicalhealth.com, the Resource Library section and Clinical Submission Forms.  You can locate the PSF Form, a tutorial, and instructions on completing the online submission under these sections, Resource Library and Clinical Submission Forms.(This can be accessed without logging in).  The WCA Help Desk has been informed by Optum that there will also be a Process Tutorial that will be populated on the website soon.

• View Patient Summary Form (PSF)
• PSF Tutorial & Instructions
• Clinical Forms Instruction Manual
• Prior Authorization Changes for Outpatient Therapy Services
  

>> Humana
If an authorization request includes procedure codes that are reviewed by both Cohere Health an Evolant, an individual authorization request must be submitted to each Humana partner. Please see the recent communication shared by a member below.

• Humana Provider Letter
• Humana Preauthorization & Notification List Changes

>> How You & Your Patients Can Get Involved

ChiroCongress Patient Campaign

Chiro Congress has created a Template Letter  for providers to send to United Healthcare to oppose the PSF-Clinical Submissions.

They also developed a Patient Campaign to educate chiropractic patients about Advantage Plans and this should prompt patients to contact their carrier and oppose. They added both United Healthcare and Humana Medicare to the patient campaign handout, this is a nationwide campaign.

• Patient Campaign for Your Clinic
• Template Letter for Providers (United Healthcare)

In December 2023, the WCA Help Desk was made aware of some changes with WPS Health Insurance. We were informed the change would directly affect WPS's adjudication of spinal manipulation for Medicare Supplement policyholders, and only spinal manipulation services. WPS stated that they sent written communication to Wisconsin Chiropractors and policy holders (patients), but we have been contacted by many members that did not receive any communications.

Read More >>

Not a member? Join WCA now and access this important information.

This will be required for both Medicare Advantage and Commercial plans, billed to Fulcrum.
Fulcrum will pay claims without the modifiers until 7/22/24. The edit will go into effect on 07/22/2024.
 
Claims after that date without the correct modifier will be denied!

Read More >>

Not a member?  Join WCA today to access this member information. 

Each July 1, the Wisconsin Department of Health Services will adjust the dollar amounts that a health care provider may charge for providing paper copies of a patient’s health care records.

There was also a 2023 Wisconsin Supreme Court ruling that drastically changed the Electronic health care records fees. DCs will want to access this new guide to make sure you are being compliant and following the new electronic records law and Paper Requests

View 2024-25 Health Care Provider Records Fees Guide>>

Not a WCA member? Join now to access this important content!

1.  a corporation, a limited liability company (LLC), or was otherwise created in the United States by filing a document with a secretary of state or any similar office under the law of a state or Indian tribe; or
2. a foreign company and was registered to do business in any U.S. state or Indian tribe by such a filing.

Reporting clinic/companies report beneficial ownership information electronically through FinCEN’s website: www.fincen.gov/boi. The system provides a confirmation of receipt once a completed report is filed with FinCEN. 

• (The WCA Help Desk advises you to print/keep this in your clinic compliance manual, once submitted)

Be sure to review FinCEN’s Small Entity Compliance Guide, which provides information to help small businesses comply with this reporting requirement. There are Twenty-three types of entities that are exempt from beneficial ownership information reporting requirements, including publicly traded companies, nonprofits, and certain large operating companies. The WCA Help Desk recommends members consult with their Accountant to make sure you meet these reporting requirements/regulations.
 
Additional Information can be found at: https://www.fincen.gov/
 
If you have any questions, please contact Tammy McKeown, CT at wcahelp@wichiro.org or 608-292-1804

Read more >>

The Wisconsin Medicaid Program began reimbursing chiropractors at the same rates as physicians for shared CPT codes starting January 1, 2024 due to a WCA-backed provision included in the 2023-2025 Wisconsin state budget.  The WCA worked with Rep. Clint Moses and Senator Rachel Cabral Guevara (pictured right) to secure this much-needed reimbursement increase.  

“Achieving payment parity within Medicaid is another step towards payment equality for chiropractors in Wisconsin,” said WCA President Dr. Chris Resch.  “The WCA will continue working to get all of our services paid for under Medicaid at rates compared to physicians.”

Please contact the WCA Help Desk at wcahelp@wichiro.org if you are experiencing any issues with Medicaid reimbursement.

View Medicaid CPT Codes >> (members only)

The Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS). Many clinicians will realize a 3.37% cut in reimbursement fees for 2024.  In addition, the 2% sequestration fee cut is still in place.  The sequestration cuts were made to preserve budget neutrality.  The Medicare Part B deductible is $240.

The 2024 CPTcode set is out, and coders will want to pay close attention to the recently rolled-out revisions, as evaluation and management (E/M) codes take center stage.

Read on for an overview of what you need to know before the 2024 codes and descriptors take effect on Jan. 1st.

Read More >>

The Wisconsin Department of Health Services routinely conducts Radiation (X-Ray) Safety inspections of Chiropractic facilities and can do so, at any reasonable time. The WCA Help Desk has been notified by members that these are being scheduled.
 
If you are notified, are you prepared?

READ MORE >

Not a member? Join now and unlock full access to the WCA Help Desk.

Did you receive the “Determine the right benefit for chiropractic claims” Flyer email from Optum? The WCA Help Desk seeks clarification from Optum.

The WCA Help Desk has been contacted this week by Members regarding a recent United Healthcare/Optum flyer that was released. This was published and shared with providers via email to help determine the right benefit for certain chiropractic claims. Tammy McKeown, CT reached out to the Senior Clinical Director at Optum for further clarification of this flyer.

READ MORE >>

Did you receive a phone call and FAX from Inovalon-Network Health requesting patient records?

If YES, they are conducting a documentation audit for any Network Health patients seen in 2022.

Learn more here (WCA members only)

Have you noticed an increase in the number of Medicare Advantage patients calling your office? Or existing patients changing plans?  A recent study revealed that in 2023, the average Medicare beneficiary can choose from 43 different Medicare Advantage plans in their area.
 
However, most Medicare Advantage plans vary on their coverage, each plan can be different. You must be in their PPO plan for the patient to have coverage for traditionally covered services such as spinal manipulation.  

Read More Here >>

The ABN, Form CMS-R-131, and form instructions are expiring as of June 30, 2023. The NEW ABN form has been issued by CMS. The use of the renewed form with the expiration date of 01/31/2026 will be mandatory on 6/30/23.

Congress struck a mostly bi-partisan $1.66 billion budget deal for 2023 that partially addresses the looming Medicare fee schedule cuts. The Consolidated Appropriations Act was introduced on December 19, 2022, and should pass the House and the Senate by tomorrow. President Biden is expected to sign it into law before the Friday funding deadline.

Here are the omnibus inclusions that impact the profession:

• A 2% fee reduction in 2023 instead of the 4.5% fee schedule cuts that were previously scheduled as a part of budget neutrality.
• An additional 1.5% reduction in Medicare fees is scheduled for 2024 as a continuing part of budget neutrality.
• A two-year postponement of the 4% in Medicare fee cuts from the pay-as-you-go sequester (PAYGO) triggered by the passage of the American Rescue Plan Act.
• An extension of the 2% sequestration for the next ten years.

As a result, the currently published fee schedule for 2023 will change, and we are recommending the following:

PARTICIPATING PROVIDERS

 If you are a participating provider with Medicare, we encourage you to continue to bill Medicare at your regular fees. Your bills will be processed based on the appropriate fee schedule once released.

NON-PARTICIPATING PROVIDERS

 If you are NOT a participating provider for Medicare, we recommend that you wait to submit your bills until the correct schedule is released. However, based on our information, you may be able to process your claims using the currently published 2022 rates and inform your patients that additional amounts may be owed or require refunding.

Chiropractors seeing a Medicare-eligible patient may not opt-out of Medicare.