NewsFlash

April 2022

Medical Necessity Requirements for Chiropractic Manipulative Treatment

Claim edits pertaining to the substantiation of the level of CMT performed have been updated and enhanced which aligns with Fulcrum Health’s Clinical Policy regarding the use of Chiropractic Manipulative Treatment (CMT). For dates of service on or after 7/1/2022, reimbursement for Chiropractic Manipulative Treatment codes must be supported on the claim form with the appropriate number of regions identified with appropriate diagnosis codes. Technique-based protocols, office routine, or provider philosophy alone are not acceptable methods for determining proper CMT code selection.  For example, adjusting only the low back and coding 98941 would require three distinct diagnoses for the low back on the claim form, and chart notes need to support diagnoses with exam findings in all three areas. Please review Fulcrum Health’s Clinical Policy (CLINUM101) on Fulcrum's Provider Portal, under the Clinical Policies tab, for more information.

Incentive Program for ChiroCare Network Providers

As a reminder, we offer an incentive for eligible CCoE clinics and providers with a Gold tier assignment for submission of clinical outcome information. In addition to the financial incentive, submitting your clinical outcomes shows how you compare to your peers and generates shared learning from colleagues.  More information on the incentive and the eligibility guidelines are available for Gold tier providers in Fulcrum's Provider Portal under the Quality Rewards tab in the Learning Hub section of portal.

ChiroCare Centers of Excellence Clinics News Release

We are excited to announce additional clinics were awarded the CCoE designation in 2022! The ChiroCare Centers of Excellence designation grew out of Fulcrum Health’s 2013 National Task Force on Spine Care, which identified the key qualities of clinics that exemplify a value-based, patient-centered approach to advancing the treatment of low back pain. This year’s additions bring the number of ChiroCare Centers of Excellence to a total of 193 providers at 102 locations across Minnesota, Wisconsin, and South Dakota. The designation recognizes their ability to meet evidence-based guidelines and stringent quality standards designed to put patients at the center of the treatment experience. To view the news release in its entirety, click here.

Correct Patient Information is Key to Accurate Claims Processing

Maintaining current insurance information for patients is essential to successful and timely claims processing. Please remember to verify that the information on the claim submission matches the information of the patient receiving the service (name, member ID number, birth date, address, etc.) This is especially important, as members of UCare Prepaid Medical Assistance Program (PMAP), MinnesotaCare (MnCare), UCare Connect, UCare Connect + Medicare, Minnesota Senior Care Plus (MSC+) and UCare’s Minnesota Senior Health Options (MSHO) plans have received updated member ID cards with new member ID numbers in 2022. When submitting a claim, the UCare member ID number listed on the card should be submitted exactly as provided; no digits should be added or excluded. Please note that all UCare members have their own unique member ID number. (Do not submit claims using the subscriber ID number with a dependent code.) It is strongly recommended that providers are checking member eligibility and benefits prior to every scheduled appointment.

ChiroCare Centers of Excellence (CCoE) Online Application Acceptance for Year 2023

We are now accepting applications from ChiroCare network providers who believe their clinics meet the Centers of Excellence criteria. The application period has been extended to May 14, 2022. Fulcrum is excited to announce that the CCoE Self-Assessment, Application, and Attestation can now be completed online for administrative ease. Please log into fulcrumproviderportal.com, go to Learning Hub tab and then the CCoE tab to access the necessary documents to apply. If you have completed the CCoE self-assessment and received a passing score of 20 or higher, please consider completing the CCoE application. Learn about Centers of Excellence best practices while receiving continuing education credits by taking Fulcrum’s ChiroCare Centers of Excellence Educational Courses! These courses were developed in partnership with Southern California University and are presented through National University of Health Sciences and can be accessed in Fulcrum's Provider Portal under the CCoE tab.   Current CCoE's do not need to re-apply. Verification review of records begins February 2022.   We encourage you to take a close look at the CCoE program overview. The self-assessment tool will assist with determining your readiness to apply. If you have any questions about the ChiroCare Centers of Excellence program, please contact Dr. Vivi-Ann Fischer v.fischer@fulcrumhealthinc.org.

Changes in Your Practice? Let us Know! It is vital that you report any practice changes to ensure that we have your current address, phone, fax, and email address. Any changes or corrections to your TIN/name combination should be communicated immediately. The Demographic Updates tab within the Fulcrum Provider Portal offers a quick and electronic means to report changes.  Please email Contracting@fulcrumhealthinc.org with any questions about submission of updates.

We appreciate your continued partnership!