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Chiropractic Services

Chiropractors should request authorization for chiropractic services for certain Blue Cross Blue Shield of Massachusetts members. WholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC, administers the program.

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Which members need authorization?

Many, but not all, members in these plans need an authorization for chiropractic services. Please check benefits and eligibility to determine if authorization is required.

Plan name Additional information
HMO/POS plans
Access Blue Basic
Access Blue Basic Saver
Access Blue Select Saver $2,000
If the member has a 12 visit limit to their chiropractic benefits, authorization doesn't apply.
HMO Blue $1,000 Deductible
HMO Blue $2,000 Deductible
HMO Blue Basic Copayment
HMO Blue Basic Deductible
HMO Blue Essential
HMO Blue Premium
HMO Blue Select $1,000 Deductible
HMO Blue Select $1,000 Deductible with Copayment
HMO Blue Select $2,000 Deductible
HMO Blue Select $2,000 Deductible with Copayment
HMO Blue Select $3,000 Deductible
HMO/POS New England Plans (some account exclusions apply)
Access Blue New England Includes members who:
  • Have a Blue Cross Blue Shield of Massachusetts-contracted primary care provider
  • Are being treated by a Blue Cross Blue Shield of Massachusetts-contracted chiropractor.
HMO Blue New England
Network Blue® New England
Blue Choice® New England (POS)
Blue Choice® New England Plan 2 (POS)
PPO Plans
Medicare PPO Blue and members of our Federal Employee Program (FEP) are not included.
PPO members living in Rhode Island are not included in the program.
(The program only applies to a small sub-set of PPO members; be sure to check benefits and eligibility)
Advantage Blue® The program applies when the member:
  • Lives inside or outside of Massachusetts (not if the member lives in Rhode Island)
  • Receives services inside or outside of Massachusetts.
Blue Care® Elect
Preferred Blue®
How to check member benefits and eligibility

Use Online Services() to see if the member requires authorization.

You’ll see this message as shown below: Prior authorization for in-network chiropractic care not required for the first 12 visits, but may be required for covered visits 13 and beyond. 

If the member does not have a benefit limit for chiropractic services, then authorization is required for visits 13 or more.

If the member has a 12 visit benefit limit for chiropractic services, you’ll see the message shown below. This member does NOT need authorization because they aren’t covered for more than 12 visits.

How to request an authorization

Request authorization before the member's 13th visit. You can do this using WHN’s telephone- or web-based Rapid Response System().

Authorization requests must be submitted within seven days (+/-) from the date of the member’s 13th visit.

Information to have ready when making authorization requests

It’s helpful to have the following information ready to enter into the RRS (web or phone-based).

  • Your telephone RRS code, which you received in the mail from WHN (only if submitting the authorization by phone)
  • The member’s ID number (prefix and suffix are not required) and date of birth.
  • The injury mechanism (auto accident or work-related injury) or the presence of other insurance (if the other health insurance is primary and coordination of benefits applies).
  • The member’s score from the Patient-specific Functional Scale (leave blank if member refuses to answer questions). The Patient-specific Functional Scale is available in English, Spanish, and Portuguese.
  • Primary, secondary, and/or tertiary diagnosis codes.

You should also have the member’s medical record available since you will be asked multiple questions about the member’s diagnosis(es), medical history, and treatment plan.

Please refer to the Chiropractic Care Plan Authorization Request Form in the Appendix of the Chiropractic Services Authorization Program Guide for a complete list of the questions you will be asked to enter into the RRS.

Tips for using the Rapid Response System to make authorization requests
  • Web browser compatibility: Works best with Internet Explorer 11.
  • Communication preferences: To get messages from WholeHealth Networks (WHN) about your authorizations, you’ll need to set up your communication preference. Choose either email or fax. You can change your preferences at any time.
    • For email, we suggest using an email address that others in your office (who handle authorizations) can access because an email can only go to one email address. When an email goes out about an authorization that has posted to the site, the email will be directed to that preferred email address. Then, you’ll need to log in to get the details about your patient.
  • Message center: Your message center is your inbox. There, you’ll be able to track messages WHN posts about your authorizations, appeals, requests from WHN’s Utilization Management Department, or if additional information is needed to complete your authorization request.

When a message is posted, you get an email. Please make sure your system is set up to receive emails from noreply@tivityhealth.com, so messages don’t go into your spam or junk folders.

Resources

Rapid Response System() (or call 1-866-726-1713)

WHN's dedicated support line: 1-866-656-6071

Chiropractic Services Authorization Program Guide

UM Department Request Form

Patient-specific Functional Scales

English

Spanish

Portuguese

Payment Policy

Chiropractic