Attention: Chiropractic and Podiatry Providers Prior Approval for Chiropractic and Podiatry Services for MPW

Effective December 14, 2015, NCTracks will begin accepting PA requests for the authorization of chiropractic and podiatry services for medically necessary pregnancy-related services for recipients with MPW coverage.

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

Note: Other services that may be necessary to treat a pregnancy-related complication already have processes in place to evaluate the medical necessity of the requested service. These services include:

·         Durable Medical Equipment,

·         Home Health Services,

·         Home Infusion Therapy,

·         Hospice,

·         Personal Care Services,

·         Private Duty Nursing, and,

·         Optical Services.

Providers are also reminded that dental services are covered only through the day of delivery for recipients with MPW coverage.

All PA requests for chiropractic and podiatry services must submitted via the provider portal. Paper versions of the request submitted by mail or fax will not be accepted. Providers will access NCTracks communications for information related to upcoming training events about this process.

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 CSC. 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 December 8 and 11. 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 November 24 training announcement.