MEMBER RESOURCE LIBRARY
Forms, Templates & Resources
Every KAC member form, flyer, guide and marketing kit in one searchable place. Use of these resources is subject to the Terms of Use and License of KAC Forms, Templates and Resources.
232
Documents
8
Categories
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Email the KACInsurance & Coding (20)
Coding references, payer contact lists, appeal letters and billing guides for everyday claims work.
01.2026 Sample Appeal Letter – WC
Sample appeal letter template for a disputed workers' compensation claim.
03.2026 WholeHealth Tivity update
Update on WholeHealth/Tivity network participation and requirements.
07.2026 KY Insurance Network List
Current list of insurance networks and payers operating in Kentucky.
10.01.2023 ICD10 KAC Quick Reference Guide
Quick-reference guide to commonly used ICD-10 diagnosis codes in chiropractic practice.
11.2024 UHC response
Record of KAC's correspondence with UnitedHealthcare on a member reimbursement issue.
2023 Anthem provider rep list
Contact list of Anthem provider representatives by region.
2025 Edits – Its the Law
Summary of recent legal and regulatory changes affecting Kentucky chiropractors.
2026 DMS instructions to renew
Step-by-step instructions for renewing your DMS (controlled substance) registration for 2026.
AIM postponement indefinitely letter from DOI
Letter from Kentucky's Department of Insurance confirming indefinite postponement of the AIM prior-authorization program.
CF Bundled Code flyer
Flyer explaining bundled CPT coding rules for chiropractic claims.
CF Copay flyer
Patient-facing flyer explaining copay obligations.
CF Insurance Models Flyer
Overview flyer comparing common insurance plan models.
CF Prior Auth flyer
Flyer explaining the prior-authorization process for patients.
Chiropractic Future Prior Authorization Toolkit
Toolkit of resources for navigating prior-authorization requirements.
ICD-10 Quick Reference Guide
Quick-reference guide to commonly used ICD-10 diagnosis codes in chiropractic practice.
Indiana Alpha prefix list for Anthem
Reference list of Anthem member ID alpha prefixes for Indiana.
Ohio alpha prefix list for Anthem
Reference list of Anthem member ID alpha prefixes for Ohio.
PIP Assignment clean
Current version of the Personal Injury Protection (PIP) assignment of benefits form.
Re exam toolkit – Practisync Gwillliam
Toolkit on re-examination documentation and billing best practices.
UCC Lien
Guidance and form for filing a UCC lien to secure payment on a personal-injury claim.
Prior Authorization Toolkit (Final PDF)
Final version of the Chiropractic Future prior-authorization toolkit.
DMS Renewal Instructions
Kentucky Medicaid (DMS) renewal instructions.
Implementing a UCC Lien on Auto Accidents
Explanation of how to implement a UCC lien on auto-accident claims.
No Surprises Act & Good Faith Estimates (6)
Everything required under the No Surprises Act, patient notices, office posters and the Good Faith Estimate workflow.
CMS FAQ GFE
CMS's official FAQ on Good Faith Estimate requirements.
CMS Required poster for your office
Required No Surprises Act poster for display in your office.
GFE Ricks language for website
Suggested website disclosure language for Good Faith Estimate requirements.
KY GFE Flow Chart
Flowchart walking through Kentucky's Good Faith Estimate process step by step.
Patient GFE editable form
Editable Good Faith Estimate form to issue to self-pay patients.
Right to receive good faith estimate editable
Editable 'Right to Receive a Good Faith Estimate' patient notice.
No Surprises Act: What You Need to Know
KAC article explaining the No Surprises Act and Good Faith Estimates.
Medicare (6)
ABN forms, Medicare Advantage patient materials and legislative advocacy resources.
03.2026 ABN
Current Advance Beneficiary Notice of Noncoverage (ABN) form for Medicare patients.
03.2026 ABN form instructions
Instructions for properly completing and issuing the ABN form.
HR 1610 Medicare patient postcard QR code – PNG
Printable patient postcard (image file) with QR code for HR 1610 Medicare advocacy.
HR 1610 Medicare Patient QR code – PDF
Printable patient postcard (PDF) with QR code for HR 1610 Medicare advocacy.
Medicare Advantage Patient Campaign V2 – KAC
Patient-facing campaign materials on Medicare Advantage coverage for chiropractic care.
Medicare FAQs Part C from CC-MAC Committee
FAQ on Medicare Part C (Medicare Advantage) prepared by KAC's CC-MAC committee.
ACA & Managed Care (4)
Model policy language and appeal tools from the American Chiropractic Association's managed care program.
01.2026 ACA E and M
ACA guidance on Evaluation & Management (E/M) coding for chiropractic claims.
01.2026 ACA E and M appeal letter
Template appeal letter for a denied E/M coding claim.
01.2026 ACA Evidence Based Benefit Design
ACA overview of evidence-based benefit design as it applies to chiropractic coverage.
01.2026 ACA Model Chiropractic Coverage
ACA's model policy language for chiropractic coverage in health plans.
HIPAA & Compliance (3)
Privacy and compliance templates, including substance-use-disorder recordkeeping.
BAA Checklist for the Chiropractic Office
Checklist for reviewing Business Associate Agreements (BAAs) with your vendors.
SUD NPP Draft Language Updated
Updated draft language for Notice of Privacy Practices covering substance use disorder (SUD) records.
SUD Related Disclosure Tracking Log Template updated
Template log for tracking disclosures of substance-use-disorder-related records.
New Federal Privacy Rules for Substance Use Disorder Records
What Kentucky chiropractors should know about the new federal SUD record privacy rules.
New Graduates (1)
Guidance built specifically for chiropractors in their first year of practice.
QMT what to avoid during 1st year
Guidance on common pitfalls to avoid during your first year in practice.
Practice & General (3)
Governance records, workplace posters and other practice-wide resources.
Required Workplace Posters – over 15 employees
Required federal and state workplace posters for offices with 15+ employees.
Required Workplace Posters – under 15 employees
Required federal and state workplace posters for offices with fewer than 15 employees.
Scat 6
SCAT6 (Sport Concussion Assessment Tool) form for evaluating suspected concussions.
F4CP Marketing Library (175)
Monthly marketing kits from the Foundation for Chiropractic Progress (F4CP), roadmap, full materials and social assets for each month since late 2022, plus general-purpose flyers and videos you can use any time. Click a year to expand it.
2022 (4 months)
December 2022
October 2022
September 2022
2023 (12 months)
September 2023
February 2023
January 2023
2024 (12 months)
2025 (12 months)
December 2025
November 2025
October 2025
September 2025
June 2025
May 2025
April 2025
March 2025
2026 (10 months)
September 2026
February 2026
Evergreen F4CP Flyers & Videos
2022 Better Posture Social Media Cover
2022 Drug free pain management
2022 Effective care
2022 Fall prevention
2022 Family care
2022 health workforce
2022 Low back pain
2022 military and vet care
2022 optimal performance
2022 optimized health
2022 personal injury care
2022 womens health
2023 Choose Chiropractic FB Cover
2023 Falls Prevention
Bull riders Career
F4CP Body and mind
F4CP Bull Rideres for Conumers
F4CP Commercial
F4CP Olympic Commercial
F4CP Pickleball Commercial
F4CP Pregnancy Commercial
Olivia Athens Chiropractic Video
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