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Essential resources for those who provide chiropractic care to patients.
Section 3.5 of the Participating Chiropractic Agreement states that chiropractors are expected to refer patients to other Participating Chiropractors or Participating Providers. Included are Participating Durable Medical Equipment (DME) providers, Preferred Physical Therapy and Occupational Therapy providers, Preferred Medical Doctors (PMD), and any other specialty for which there is a network. Find a provider in their respective network, with "Find a Doctor."
Sections 4.2, 4.6, and 4.13 of the Participating Chiropractic Agreement pertain to licensing issues. Chiropractors agree to maintain in good standing all licenses required by law, and to notify Blue Cross in writing within 72 hours of any action against the chiropractor’s licensure, whether temporary or permanent.
Professional courtesy and the requirement to collect copayments and deductibles is addressed in section 4.5 of the Agreement. Chiropractors may waive a particular copayment or coinsurance amount for reasons of professional courtesy. If the chiropractor, except in cases of professional courtesy, does not bill the patients these amounts or does not make a reasonable good faith effort to collect, or if the chiropractor waives or represents that he waives these amounts, the Agreement has been breached and participation may be immediately terminated.
Professional courtesy may apply when a chiropractor treats his own employees or family members of his employees, or other healthcare providers. This list is not intended to be all-inclusive, but providers should use professional courtesy at his/her own discretion. It should not be used as a marketing tool by applying it to selected “groups” of people. When professional courtesy is extended, the fees for the physician treating the patient is usually made at a reduced rate, or the copayment may be waived.
Professional courtesy does not apply when a provider is treating his/her own family members. Blue Cross and Blue Shield of Alabama does not provide benefits for the professional services of a provider rendered to a member who is related to the physician by blood or marriage or who lives in the provider’s household. Payments made in error on these claims are subject to refund recovery.
In addition to the policies found in the Participating Chiropractic Manual, our website contains medical policies that apply to providers of all specialties. Links to medical policies are located under Guidelines and Policies located on the right side of the page. Examples that might interest you are:
If you would like to receive emails informing you of updates to our medical policies, email firstname.lastname@example.org and request to be added to the medical policy distribution list. Please include your National Provider Indentifier (NPI).
For additional information contact your Provider Network Services Representative.