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Archive for Chiropractic Claims

Chiropractic Claims: Chiropractic Care vs. Physical Therapy

Physical Therapy When a patient experiences a bodily injury or physical trauma that requires treatment, they may see a chiropractor and a physical therapist. Apex EDI is familiar with both types of claims. Chiropractors routinely diagnose and treat mechanical disorders of the musculoskeletal system. Physical therapists help restore physical mobility and functioning.

Common chiropractic claims include the diagnosis of medical conditions related to joint pain. Patients often receive a chiropractic adjustment, electrical stimulation, acupuncture or pain management therapy. Sometime a chiropractor will make a referral to a specialty provider to treat ongoing traumatic conditions.  

There are at least twenty different types of techniques used by chiropractors. They include manipulation of the spine and other joints. Chiropractors can usually offer advice related to exercise, nutrition, stress-relief, relaxation, and disease prevention.

chiropractricIn some states a chiropractor may perform minor surgery. They are clinicians who are experts at conservative treatments within their scope of practice. In some states they are considered health care providers. However, they are not medical doctors and do not prescribe medicine.

Physical therapists diagnose musculoskeletal movement. Claims often include techniques such as joint manipulation, gait training, muscle coordination, massage, and cardiovascular rehabilitation. They also have the training to recognize medical conditions and refer patients to specialists as needed.

They often help people who have been in an accident or experience lower back pain, or other physical disabilities. Physical therapy is often combined with other medical practices to restore mobility and help with the rehabilitation of the patient.  

A physical therapist is considered a specialty practitioner by the insurance industry. They are also not a medical doctor and cannot prescribe medication. They use conservative treatments and provide wound care, but do not perform surgery.

Apex EDI is knowledgeable about both chiropractic and physical therapy types of claims. We specialize in medical claims processing and make it easy for you. Contact Apex EDI to request a  today.

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Chiropractic Claims: How to Bill Chiropractic Claims

Chiropractic claims are a little different than most other medical claims. Chiropractic services have only recently been considered medically necessary, and only under very specific circumstances. This makes it even more important for claims to be done correctly so as not to be rejected by insurance companies.

Who Covers the Procedures?


Most insurance companies will only cover procedures where a patient’s spinal column is manually manipulated to correct an issue of alignment, physiological function or movement integrity. This does not include any other services the chiropractor may offer such as diagnosis of the issue, although a diagnosis is necessary to show the insurance company that the service was medically necessary. As well, the patient must exhibit a significant health problem that justifies the use of manual manipulation of the spine.

This means that subjective comments from the patient, objective findings, diagnosis, and treatment must all support the medical necessity of the procedure in order to receive payment from the insurer. It’s important to make sure that you are using the proper billing codes so that it is clear what is being charged for and that the services meet all of the necessary requirements. Codes should be specific to the region that was treated, even if the entire spine was manipulated as part of the treatment. As well, patient information must be accurate and updated frequently to avoid claim denials and rejections.

Chiropractic medical claims require more explicit accounting practices than other more traditional medical claims, and mistakes can lead to headaches when having to deal with insurance companies that are hesitant to cover services. Consider hiring a medical clearinghouse that knows the ins and outs of chiropractic billing, and can ensure that you’re sending the most accurate billing information the first time. Apex EDI offers services to medical, dental, vision, and chiropractic practices and thoroughly vets claims before they are sent on to insurers. Request a demo today to see how Apex EDI can help your chiropractic practice get their claims in order.

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Chiropractic Claims: A Typical Visit – What your Chiropractic Claim Will Pay For

A chiropractor can work with you to establish goals for reducing back pain and restoring the independence you need to participate in your daily activities. At the initial consultation visit, the chiropractor will complete a thorough 45 minute exam and diagnose a treatment plan. Most will also offer advice on how to avoid future back pain or injury.

Because this practice has a variety of techniques and approaches, it is beneficial to prepare ahead of time and bring a list of questions with you. You’ll also want to bring information about your medical history and background on the current injury. The chiropractor will ask you to describe the injury and pain in detail.

Your claim will pay for an exam that includes general tests to measure blood pressure, pulse, respiration, reflexes, muscle tone, muscle strength, and neurological integrity. Depending on your specific needs, you may also be asked to perform range of motion tests which require you to move in a specific manner, posture tests, or a spinal adjustment. There are hundreds of adjustment techniques used by chiropractors throughout the world to restore joint functionality, movement, and reduce pain.

By the end of your visit, you will discuss an ongoing treatment plan that may include future spinal adjustments, ultrasound, strengthening exercises, massage and education on proper posture or nutrition. For most types of lower back pain, 1 to 3 chiropractic visits per week for 2 to 4 weeks will be prescribed, followed by a re-examination. If needed, you may be referred to other specialists until your mobility improves and the pain ceases.

It’s easy to get started by researching providers in your area. You may want to ask for recommendations and discuss chiropractic approaches over the phone with the clinic to help with your selection. Once you’ve made your choice, Apex EDI makes it easy to get your chiropractic claims paid.

Contact us to learn more.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

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Chiropractic Claims: Tips to Submit Accurate Chiropractic Insurance Claims

As an increasing number of insurance companies are providing chiropractic benefits to their subscribers, chiropractors are submitting claims to insurance more regularly. Here are a few tips for submitting accurate chiropractic claims.


Date of Service

In many states it is required to include the initial date of service within a chiropractic claim. This initial date of service is intended to provide the very first visit of the patient to your practice, in which you, as the chiropractor, provided diagnosis and treatment for the patient requiring relief from subluxation through chiropractic care.

It is important to note that “date of onset” and “date of initial treatment” are not necessarily the same date. A patient may have acquired an injury several days or weeks before the actual chiropractic treatment had been initiated. Be sure to discuss the date of onset with your patient and make a record of it for claim submission.

Therapies Provided

Detailed documentation of the exact chiropractic therapy provided is essential to accurate chiropractic claims submission. For example, if a patient is requesting treatment for lower back pain, it is required that the exact vertebra that is in subluxation be recorded within the claim. Then articulate the adjustment completed to remedy the subluxation, and any additional therapies completed to ensure proper adjustment and setting of the vertebrae or extremity.

Keeping It Organized

In order to ensure that all of your claims are properly filed and submitted, it’s important to maintain an up to date practice management software and the records that correspond with that software. In addition to the practice management software, it’s important to incorporate a clearinghouse that integrates with chiropractic claims.

One such clearinghouse is Apex EDI. Apex integrates with dozens of practice management softwares to ensure proper scrubbing of chiropractic claims. For more information about how Apex EDI can help your chiropractic practice maintain accurate claims submission, be sure to check out our Chiropractic Claims page or contact us today.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

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