Attention: Chiropractic and Podiatry Providers Reminder – PA Required for Chiropractic and Podiatry Services for MPW March 1

Effective with date of service March 1, 2016, MPW claims for chiropractic or podiatry services will deny if PA is not on file for the recipient starting March 1, 2016.

All PA requests for chiropractic and podiatry services must submitted via the NCTracks Provider Portal. Paper versions of the request submitted by mail or fax will not be accepted.

A referral is required from whoever is providing the recipient’s obstetric care (e.g., family practice physician, OB/GYN, nurse midwife, nurse practitioner, health department, etc.). The referral must document the condition that makes it medically necessary for the recipient to see a chiropractor or podiatrist. It must be specific as to how the condition is complicating the pregnancy and include the number of requested visits. The referral may or may not be to a particular chiropractor or podiatrist.

PA is not required for the initial visit. Providers may bill for an evaluation using the appropriate procedure codes. PA is required for subsequent visits/treatment. The referral may be submitted as an attachment to the PA request or it may be mailed or faxed to CSRA. No medical records, plans of care or other documentation are required to be submitted with the request.

The chiropractic (or podiatry) provider is responsible for entering and submitting the PA request through the NCTracks Provider Portal. The provider must indicate the service requested (chiropractic or podiatry) and the request begin and end dates. For chiropractic services, a primary diagnosis must be selected from a drop-down list of diagnosis codes, and a secondary diagnosis must be manually entered. For podiatry services, a valid diagnosis code per policy must be entered on the PA request.

PA cannot exceed 60 calendar days. Requests cannot be submitted retroactively (unless the recipient is approved for Medicaid retroactively).

If services continue to be needed after the initial approved limits or time period, providers must submit a new PA request. A new referral from the recipient’s primary obstetric caregiver also must be submitted indicating the medical need for the new time period being requested.

Provider Training

Training for providers is available. A Medicaid for Pregnant Women Prior Approval course is being offered on February 22 and 25. This course will provide an explanation of the PA requirements for chiropractic and podiatry services for MPW recipients. The course is taught via WebEx and can be attended remotely from any location with a telephone, computer and internet connection. For more information, see the January 25 training announcement.