Chiropractic denials come down to one modifier.
Active treatment is payable and maintenance care is not, and the difference on the claim is a modifier supported by documentation. Most practices lose the argument before it starts.
- 97%Coding accuracy on audit
- 50+Specialties covered
- 4.9/5Average client rating
Three ways Chiropractic claims quietly lose value
Review these issues against the documentation, remittance and policy that applied on the date of service. They can appear as denials or underpayments.
- Maintenance care billed as active treatment
Payers cover care that produces measurable improvement. Without documented progress the visit is maintenance, and maintenance is the patient responsibility.
- Treatment plans without measurable goals
A plan that does not state a functional goal cannot demonstrate improvement, which means every visit is arguable.
- Visit caps reached without warning
Annual visit limits are common and low. Passing one mid course leaves the patient with an unexpected bill and you with a collection problem.
What we bill for Chiropractic practices
If something you do is not on this list, ask. We will tell you honestly whether we have the depth for it.
How Chiropractic accounts are actually run
The worklist connects each claim to its documentation, payer requirements and next follow-up date.
- A chiropractic coder, not a general one
The coder assigned to your account works chiropractic every day. They already know which of your payers do what, and they are watching active treatment versus maintenance, visit caps and documented progress.
- Charges checked against the note
Before anything goes out, the charge is read against the documentation. A code the note does not support is a recoupment waiting to happen, and in chiropractic it is usually the highest value code on the claim.
- Eligibility and authorization ahead of the visit
Coverage is confirmed and any approval is in place before the service, not discovered afterwards when the work has already been done.
- Denials worked to cause, not just refiled
Every denial is tagged by payer and reason code. When a pattern shows up in your chiropractic claims we change the upstream step so it stops recurring.
- Reporting you can act on
Monthly numbers by procedure family and payer, with the one decision they imply, rather than an export nobody opens.
Included for Chiropractic practices
- Coders who work chiropractic daily
- Charge review against documentation
- Eligibility and benefit verification
- Prior authorization management
- Denial management by payer and reason code
- Aged A/R worked oldest first
- Patient statements and balance follow up
- Monthly reporting by procedure family
These describe how we run the service. They are commitments about our process, not a guaranteed outcome on any individual claim.
We work inside the system you already use
We agree user permissions, claim queues, reporting access and escalation contacts in your current system before work begins.
Chiropractic billing across the country
These state guides explain local Medicaid programs and payer administration. They cover general billing requirements, rather than a separate Chiropractic service in each state.
Arizona payer guideAHCCCS and 7+ plans
Washington payer guideApple Health and 7+ plans
Texas payer guideTexas Medicaid and 8+ plans
New York payer guideNY Medicaid and 8+ plans
California payer guideMedi-Cal and 8+ plans
Ohio payer guideOhio Medicaid and 8+ plans
Florida payer guideFlorida Medicaid and 8+ plansWhat Chiropractic practices ask
Can you tell us when care becomes maintenance?
We can tell you what the documentation is currently supporting, which is the same question from the payer point of view.
Do you handle personal injury claims?
Yes, including liens and slower settlement timelines, tracked separately from commercial.
How do you handle visit caps?
We check benefits up front and track the count so the patient is told before the cap, not after.
Can you keep cash plans separate?
Yes. Membership and cash care should never touch the insurance workflow.
Have a chiropractic coder read your last ninety days
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.