On Monday, October 25th, Dr. Jeff Meyers, KAC President, Dr. Eric Davis, KAC Government Affairs Chair, and Dr. Rachel Wendt, KAC Executive Director, met with the Commissioner of Insurance regarding the issues chiropractors are facing with CareSource.
During our meeting on Monday with the DOI, we expressed the frustration chiropractors have faced since January 2021 with CareSource. Historically, the KAC maintained an open relationship with CareSource – when issues arose for chiropractors, we were able to solve them within our discussions directly with the company. Topics discussed included the results from our survey in early January 2022. This survey was sent to all KAC chiropractors and reported as follows:
- Denials for adjustment codes when billed with an extremity code – 54.1% of providers answered had this issue,
- Denials for therapy codes for lack of prior authorization when no prior authorization is required – 62.2% of providers answered had this issue, and
- Denials for dry needling codes – 11.9% of providers had this issue – limited to those certified to do dry needling.
We also raised new issues that have come forward during our conversations and attempts to solve current problems with CareSource. These new issues include our concern for outstanding claims for chiropractors dating back to January 2021, phantom benefits, the overall lack of chiropractic policies, and the delay in creating and implementing new chiropractic policies, further delaying payments for chiropractors.
The DOI expressed frustration and concern with our issues. Moving forward, the Commissioner of Insurance will have an initial conversation with the President of CareSource regarding chiropractic concerns. After this meeting, there is an opportunity for the DOI to perform a “targeted exam” where CareSource would have to have 90% of the claims processed correctly, according to CareSource policies. If they are outside the threshold, action from the DOI will occur with penalties.
We are cautiously optimistic but feel we received our first real answers since we learned about CareSource’s chiropractic policies being “archived and deleted.” We understand a targeted exam may take time to complete and ask that we all have patience; however, we appreciate the Commissioner’s time in taking on our issues.
The KAC will continue to work with CareSource and the DOI to solve issues impacting chiropractors in the state.
On November 9, 2022, the Division of Insurance along with Commissioner Clark met with CareSource, including President Mike Taylor, regarding chiropractic billing and reimbursement issues. The DOI has instructed CareSource that all claims dating back to January 1, 2021 “be resolved including the payment of past claims with interest”. The KAC will be meeting again with the DOI and CareSource early January to follow up on these issues. Commissioner Clark stated in their update email to KAC that “If the matter is not resolved, the Department is prepared to take further regulatory action and I have expressed that to CareSource on our call this morning”.
We have subsequently heard from CareSource in that the claims for participating chiropractors from 1/1/21 to current will be processed while a new policy is finalized for chiropractors. CareSource has stated that at this time, no claims need to be rebilled with corrected diagnosis codes or modifiers. Their target completion for the claims to be reprocessed is 12/1/2022.
We are asking that if your office has received any reprocessed claims to please contact the KAC so we can monitor if claims are being paid properly with any appropriate interest or if claims are still processing in error. You can email email@example.com with any updates you have.