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.
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|
|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:
|HMO Blue New England|
|Network Blue® New England|
|Blue Choice® New England (POS)|
|Blue Choice® New England Plan 2 (POS)|
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:
|Blue Care® Elect|
Use Online Services (to be replaced with ConnectCenterTM in 2022) 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.
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.
It’s helpful to have the following information ready to enter into the RRS (web or phone-based).
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.
When a message is posted, you get an email. Please make sure your system is set up to receive emails from email@example.com, so messages don’t go into your spam or junk folders.
If you receive an adverse determination and want to appeal the determination, you will have two options for reconsideration.
Rapid Response System (or call 1-866-726-1713)
WHN's dedicated support line: 1-866-656-6071
Patient-specific Functional Scales
To download the Chiropractic payment policy, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.