Web page link

https://wichiro.org/

Membership Fees

• Pro-rated for those within first three years of practice
• Rates for benefits of Spouses of Doctors
• Newly Licensed doctors have first year free
• Students: Free

Member benefits

• “Help Desk” for daily practice challenges/questions
• Discounts on CEUs, office supplies, and other corporate partnerships
• Government Affairs and Advocacy efforts – as recent as the 2023-2024 legislative session had a pre-authorization bill the state’s legislative efforts were focused on stopping, and did successfully!
• F4CP membership
• Clinical Compass Subscription
• Other networking events

Website to apply for license: https://dsps.wi.gov/Pages/Professions/Chiropractor/Default.aspx

• • Housed in Department of Safety and Professional Services
  • Exam scores
  • Transcript – official
  • No background check or fingerprinting required
  • If licensed in another state, you can have temporary credentials while waiting for permanent credentials (licensing) from the state vis Temporary Act 10 – Form 2021-A102

Requirements:

• • NBCE Part I, II, III, IV
  • NBCE Physiotherapy: accepted
  • NBCE Acupuncture: not accepted
  • Additional board approval required for certification and use of therapeutic ultrasound, galvanic therapy, and nutritional counseling
  • Bachelor’s degree required
  • Jurisprudence exam (open book)
    • Exam information: https://dsps.wi.gov/Pages/Professions/Chiropractor/Exams.aspx

Travel to treat not authorized

Telemedicine not authorized

Preceptorship: students may practice under a licensed D.C. in a preceptor program when approved for temporary license.

To examine into the fact, condition, or cause of departure from complete health and proper condition of the human; to treat without the use of drugs as defined in s. 450.01 (10), other than hemp, as defined under s. 94.55 (1), or surgery; to counsel; to advise for the same for the restoration and preservation of health or to undertake, offer, advertise, announce or hold out in any manner to do any of the aforementioned acts, for compensation, direct or indirect or in expectation thereof; and (b) To employ or apply chiropractic adjustments and the principles or techniques of chiropractic science in the diagnosis, treatment or prevention of any of the conditions described in s. 448.01(10).

• See link about administrative code: https://dsps.wi.gov/Pages/RulesStatutes/Chiropractors.aspx

CEU (for renewal) requirements

• Biennial renewal on 12/15 of even numbered years
• 20 hours per year (40 per renewal)
  • 8 hours max. online , with 50% synchronous format
  • 1 credit AED coursework per renewal may count
• CPR certification required
• Does not accept PACE

Step by step instructions

https://www.nata.org/sites/default/files/apply_npi_instructions.pdf

Step by step instructions

https://sa.www4.irs.gov/modiein/individual/index.jsp

Note: This is your tax ID number as a practitioner

State specific rules

• Filing for a business
  • https://www.ilsos.gov/departments/business_services/home.html
  • This link has online services to file for and apply for LLCs and other legal business entities.
    • Reserve a name – must be unique
    • Assign registered agent
    • Registered office – street or road address, or rural route and PO box number for location – you cannot have just a PO box
    • Fees to file are based on a 10 business-day period, you can pay a greater fee to have business documents finalized in 24 hours.
  • FinCEN required (federally) with reporting

TYPE OF BUSINESS BREAKDOWN

Note: The difference between an LLC and a PLLC is that all members of PLLC are required to be designated professionals.

What is an Associate?

An associate receives pay from the office by which they are employed. If you are an associate who will be dealing with vendors for selling goods, you should consider getting an EIN.

What is an independent Contractor?

An independent contractor receives pay from their patients and insurance companies directly. If you are an independent contractor, you need an EIN.

• NCMIC – https://www.ncmic.com/malpractice-insurance/how-to-apply-online/

• OUM – https://www.oumchiropractor.com/quote/apply

• ChiroSecure – http://chirosecureform.com

• PRI – https://www.pri.com/who-we-serve/chiropractors

• General Liability Insurance – https://generalliabilityinsure.com/small-business/chiropractic-insurance.html

• ChiroFuture – https://chirofutures.org/online-quote/

• SDN Insurance – http://sdnins.com/chiropractor.html

• CoverMD – http://www.covermd.com/chiropractor-malpractice-insurance.aspx

• Insureon – https://alliedhealth.insureon.com/resources/cost/chiropractic

• MBS Insurance Services – https://www.mbsinsure.com/solutions/malpractice-insurance/

• USA Business Insurance – https://www.businessinsuranceusa.com/chiropractor-professional-liability-insurance

• CM&F – https://www.cmfgroup.com/professional-liability-insurance/chiropractic-assistant-insurance/

• MACARIO Insurance Group – https://www.macarioinsurance.com/who-we-cover/all-classes-of-business/

• Chiroprefered – https://chiropreferred.com/find-the-right-coverage

Claims Made

A policy providing coverage that is triggered when a claim is made against the insured during the policy period, regardless of when the wrongful act that gave rise to the claim took place. (The one exception is when a retroactive date is applicable to a claims-made policy.)

Occurrence

An occurrence policy covers claims resulting from an injury or another event that occurs during the policy term. Coverage depends on the timing of the event. A claims-made policy covers claims that are made during the policy period.

Tail Coverage

An addition to a claims-made policy. It extends coverage for incidents that happened during the time you had your policy, but a claim was not filed until after your policy expired or was canceled. Tail coverage is another name for an extended reporting period.

Note: $1 Million/$3 Million is the minimum plan required in order to participate with some Insurance Companies.

Common insurance companies include United Health Care, Anthem (BCBS), Aetna, Cigna, Molina, Security Health Plan, Medica, Health Partners, AspirusArise, Network Health, and Quartz (Fulcrum Health). Links below allow you to apply for participation in their networks.

• • UHC (viaOneHealth) https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
  • Anthem: https://www.anthem.com/provider/credentialing/?cnslocale=en_US_wi
  • Aetna: https://www.aetna.com/health-care-professionals/join-the-aetna-network.html
  • Cigna: https://www.cigna.com/health-care-providers/credentialing/join-medical-network
  • Molina (Medicaid) https://www.molinahealthcare.com/providers/wi/medicaid/home.aspx
  • Security Health Plan: https://www.securityhealth.org/providers/provider-manual/shared-content/provider-rights-and-responsibilities/provider-credentialing-process?rights-and-responsibilities-medicare-advantage
  • Medica (Dean Health Plan): https://providernetworkapplication.deancare.com/deancare
  • Health Partners: https://www.healthpartners.com/provider-public/credentialing-and-enrollment/
  • Quartz (Fulcrum Health): https://quartzbenefits.com/new-provider-forms/
  • Network Health: https://networkhealth.com/provider-resources/credentialing-and-provider-informatics
  • AspirusArise (First Health Network): https://secure.wecareforwisconsin.com/aspirus_arise/find_a_doctor

CoOperatives

• • Wisconsin also has several common Co-operative organizations that work in place of traditional health insurance providers. Some vary by region. Providers should still be in network with these organizations. Examples include:
  • Group Health Cooperative: https://ghcscw.com/plan-providers/request-to-join-ghc-scw-network/#:~:text=The%20credentialing%20process%20for%20the,(1)%20year%20to%20reapply.
  • Common Ground: https://commongroundhealthcare.org/become-a-provider/

As of this writing, most private insurance companies rely on the Council for Affordable Quality Health Care (CAQH) to verify your credentials. You will also need CAQH credentialing for some of the government supplemented participations as well. Others will use Availity for your credentialing, however as of this writing that is becoming less common. Keep in mind, you only need one account on either of these, and then will give permissions to each insurance company you are working to participate with to access your information and to be verified as a provider.

• • Availity: https://www.availity.com/essentials
• CAQH: information needed can be filled out here: https://proview.caqh.org/Login/
• The following is a quick step by step of what things you should select as a chiropractor and documents/information you may need.

1. 1. 1. NUCC Grouping: Chiropractic Providers
      2. Provider type: Doctor of Chiropractic
      3. Select your state
      4. Social security number
      5. Demographics and contact information
      6. License number(s) and state(s)
      7. Educational information (about your chiropractic school and degree)
      8. Board certified: No (chiropractors are not board certified, and do not need to be)
      9. You may select directory listings and other searchable tags
      10. Practice location(s), including TIN
      11. You may add credentialing contact information if you are using a third party, but if you are doing this yourself you may skip this section.
      12. Malpractice insurance information: company, expiration dates, and policy numbers.
      13. 10 year work history, dates, addresses, etc.
      14. Professional disclosures
      15. Documents to upload:
          1. Standard authorization release; updated every 120 days
          2. Professional liability insurance verification (proof of insurance)
          3. State license (copy)
          4. W9

Medicare Enrollment:
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf

Medicare Revalidation: PECOS:
https://www.youtube.com/embed/PaLEWx0JGPw?rel=0&autoplay=0

Tips For Medicare Audit/Record Request Tips
https://www.acatoday.org/Practice-Resources/Medicare/Medicare-Audit-Record-Request-Tips

Type Of Audit And Record Requests
https://www.acatoday.org/practice-resources/medicare/medicaretpe/

Targeted Probe And Education (TPE)
http://www.acatoday.org/MedicareTPE

Medicare Training For The Chiropractic Office
https://learn.acatoday.org/products/medicare-training-for-the-chiropractic-office

How To Bill Secondary Insurance Plans
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance

Which Insurance Pays First
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance/which-insurance-pays-first

• Manual manipulations of the spine to treat subluxations
  • 20 visits per year, then prior authorization
  • Spinal supports may be approved with prior authorizations
  • X-rays are covered services only for initial visits, other conversed services include urinalysis when related to diagnosing a subluxation or verifying symptomatic conditions beyond the scope of chiropractic practice.
  • HMO plans are not required to cover chiropractic, but may elect to provide coverage or treating providers may enroll as a fee-for-service membership which requires various other policies and prior authorizations based on the agreements.
• BadgerCare, Molina Health, and Forward Health are common providers with chiropractic coverage.
• Handbook:
  • https://docs.legis.wisconsin.gov/code/admin_code/dhs/101/107/16
  • Diagnostic urinalysis: Includes common notes around covered services, yet for chiropractors other covered services must be related to the diagnosis of a spinal subluxation or when verifying a symptomatic condition beyond the scope of chiropractic care (example from Forward Health: https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=8&s=2&c=61&nt=

• Chiropractors are listed as an option for workers to select as their choice of provider for work related injuries
• Further information from the Department of Workforce Development: https://dwd.wisconsin.gov/wc/medical/med-treatment-selection.htm