Insurance Updates

UnitedHealthcare has announced that prior authorization will no longer be required for the three chiropractic manipulative treatment codes on its Medicare Advantage and Dual Special Needs (D-SNP) plans. What Is Changing Beginning October 1, 2026, UnitedHealthcare will no longer require prior authorization for the following CPT codes under its Medicare Advantage and Dual Special Needs…

This guidance was obtained through the Medicare Advisory Committee (MAC), led by ChiroCongress and co-chaired by Dr. Brad Stauffer and Dr. David Kassmeier. The Kentucky Association of Chiropractors participates in this group on behalf of Kentucky-licensed chiropractors. Download the full FAQ article here. This article is part of a KAC Table Talk series on frequently…

This guidance was obtained through the Medicare Advisory Committee (MAC), led by ChiroCongress and co-chaired by Dr. Brad Stauffer and Dr. David Kassmeier. The Kentucky Association of Chiropractors participates in this group on behalf of Kentucky-licensed chiropractors. Download the full FAQ article here. This article is part of a KAC Table Talk series on frequently…

This guidance was obtained through the Medicare Advisory Committee (MAC), led by ChiroCongress and co-chaired by Dr. Brad Stauffer and Dr. David Kassmeier. The Kentucky Association of Chiropractors participates in this group on behalf of Kentucky-licensed chiropractors. This article is part of a KAC Table Talk series on frequently asked questions about Medicare Advantage plans…

This guidance was obtained through the Medicare Advisory Committee (MAC), led by ChiroCongress and co-chaired by Dr. Brad Stauffer and Dr. David Kassmeier. The Kentucky Association of Chiropractors participates in this group on behalf of Kentucky-licensed chiropractors. Download the full FAQ article here. This article is part of a KAC Table Talk series on frequently…

This guidance was obtained through the Medicare Advisory Committee (MAC), led by ChiroCongress and co-chaired by Dr. Brad Stauffer and Dr. David Kassmeier. The Kentucky Association of Chiropractors participates in this group on behalf of Kentucky-licensed chiropractors. Download the full FAQ article here. This article is part of a KAC Table Talk series on frequently…

NOTE: There is an updated article regarding the 4% cut. That article can be found here. FROM:   Lisa D. Lee, Commissioner DATE:   June 8, 2026 RE:     Medicaid Budget Impact on Provider Reimbursement Dear Provider Partner, As you may be aware, House Bill 500, passed in the 2026 Kentucky General Assembly Session, did not provide sufficient funding for the…

Dear KAC Members, Please review the following updates regarding two current insurance issues affecting Kentucky chiropractors. PASSPORT: RECOUPMENT OF 97XXX CODES Passport is attempting to recoup 97xxx codes on previously submitted claims where the GP modifier was not used. If your claim is affected, we encourage you to act promptly. You may submit a corrected…

Below is an email we sent to doctors using the latest list of Infinedi users we had from from January 2025 regarding Infinedi. We understand that list may not be current or all inclusive as of 2026, hence the post here. As we know more or hear directly from Infinedi, we will update this post…

Question: Do I have to update my chiropractic license with DMS every year? Answer: The quick and short answer is yes. The license sometimes, but not always, updates - you should take a minute to double check your license has been updated to avoid delays in billing. Longer answer and instructions: If you participate in…

Click here to read the full article and original post. UnitedHealthcare (UHC) announced on May 5, 2026, that it will eliminate prior authorization requirements for an additional 30% of healthcare services by the end of 2026. Notably, the list of services being freed from prior authorization includes certain outpatient therapies and chiropractic care, along with…

Humana Medicare Advantage Update KAC has been actively monitoring and advocating on a Humana Medicare Advantage claim processing issue that has affected providers since late 2025. We want to provide members with a full update on where things stand today. Background In late 2025, KAC began receiving reports of Humana Medicare Advantage claim denials tied…

If you bill Medicare or Humana Medicare Advantage, there are several updates in effect right now that affect your claims, your compliance, and your reimbursement. Here is a quick rundown of what you need to know. Want to HEAR these changes in stead of read - scroll down for the video! 1. Humana Medicare Advantage:…

2026 - Effective 04/01/2026 - Kentucky Part B Physician Fee Schedule NOTE: The 2026 Medicare Fee Schedule has been updated as of 4/1/2026. To see the previous fee schedule, click here. Results matching 98940: # – These amounts apply when service is performed in a facility setting. C – The payment for the technical component…

Humana has announced that effective July 1, 2026, a $5.00 administrative fee will be assessed on each paper claim submitted on a CMS-1500 or UB-04 form for Medicare Advantage plans. This fee applies when the reimbursement amount for the claim is equal to or greater than $10.00. To avoid this fee, Humana strongly encourages providers…

We want to make sure you are aware of an upcoming change from WholeHealth Living that takes effect on April 1, 2026, just around the corner. Beginning April 1, all authorization requests for WholeHealth Living must be submitted through the WholeHealth Living Payer Space on Availity (www.availity.com). This replaces any previous submission process you may…

Question I thought the new ABN was released? Can you confirm? Answer Yes! As of March 13, 2026 - the new ABN is now released. We've made it easy for KAC members to download the new ABN. Medicare has released an updated version of the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and chiropractic…

KAC Member Question: One of the PIP carriers have started paying patients directly. Does KAC have a template we can use to help ensure PIP payments are directed to our office? Answer: Yes. KAC has developed a customizable Kentucky PIP Direction of Payment template to help clarify patient intent and support direct payment of PIP…

Humana Medicare Advantage Update KAC has received a recent update from Humana’s code edit department regarding the Medicare Advantage claim denials that were previously reported. Background on the issue:In late 2025, KAC began receiving reports of Humana Medicare Advantage claims being denied or inconsistently processed, particularly related to Local Coverage Determinations (LCDs). Toward the end…

The Advance Beneficiary Notice of Noncoverage (ABN), which must be provided to patients when Medicare may not cover a service, is currently scheduled to expire on January 31, 2026. Chiropractic physicians should be aware that the Centers for Medicare and Medicaid Services (CMS) has not yet released an updated version of the form. No New…

Humana Medicare Advantage We have begun to see Humana Medicare Advantage claims processing with payments issued toward the end of December. This is a positive development. We are continuing to actively monitor claims activity to ensure consistency and to identify any remaining issues. If you continue to experience denials or irregular processing, please report those…

The Kentucky Association of Chiropractors has been made aware of a developing issue involving Humana Medicare Advantage plans. It has come to our attention that certain Humana Medicare Advantage replacement plans are denying chiropractic claims based on local coverage determinations (LCDs) and national coverage determinations (NCDs). The stated denial reason is that the “procedure being billed is not…

Starting December 18, 2025, claims that meet the criteria below must be submitted directly to Anthem. This update removes the need to verify the member’s home address, enhancing claims filing efficiency. If you do not have a contiguous contract, this change will not affect you. Claims that meet the following criteria must be submitted directly…

NOTE: These fees have been updated as of 4/1/2026. See updated article here. Question: What is the 2026 Medicare Fee Schedule Answer: While this isn't a traditional table talk question - it fits the category! Overall, there is a small increase (0.32%-1.68%) in the fees schedule from 2025. Remember, the 2026 Medicare deductible is: $283,…