Web page link

https://www.nysca.com/

NYSCA District Breakdown

https://www.nysca.com/districts

Application

• Practitioner Application Form
  • Mail-In: https://nysca.memberclicks.net/assets/docs/membershipapplication.pdf
  • Digital: https://nysca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2019841
• Student Application Form: https://nysca.memberclicks.net/student-membership

Membership

• Member Landing Page: https://www.nysca.com/membership-dashboard
  Contains; Event Calendar, upcoming CE opportunities, upcoming webinars and other resources
• Member Benefits: https://nysca.memberclicks.net/member-benefits

NBCE requirements

• Parts I*, II*, III* and IV*: Required – PASSING SCORE IS 375
• Physiotherapy: NOT Required
• https://mynbce.org/

NONE

• Fee: $294 (subject to change)
• Fill out forms
  https://www.op.nysed.gov/professions/chiropractic/license-application-forms

1. Application for Licensure*
2. Certification of Education*
3. Verification of Chiropractic Licensure in Another Jurisdiction**
4. Verification of Experience**

*NECESSARY FOR ALL NEW PRACTITIONERS

**NECESSARY FOR PRACTITIONERS TRANSFERRING FROM ANOTHER STATE OR TERRITORY

Scope Modernization – https://www.nysca.com/scope-modernization

Doctors of Chiropractic are required to have 36 CEs every 3 years

• Breakdown of required CEs:
  • 12 Category 1 (Ethics, Documentation and Patient Communication)
  • 24 Category 2 (Clinical)

Note: These are the base requirements, they can be exceeded but must be met every 3 years

Note: Attain and keep a record of all CEs, auditors will ask for proof of completion

Note: Some Insurance Companies require more than these 36 CEs for participation. Check with NYSCA for details

Note: New practitioners are exempt from CEs for the first three years they are in practice. This is true to maintain a license but may not be true to maintain participation with certain Insurance Providers

Note: NYSCA offers CEs at a discounted rate for members year-round, including fall and spring CE conferences. Visit https://www.nysca.com for details.

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

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.

NYSCA Region Breakdown

https://www.nysca.com/districts

NYSCA REGION 1 (THE 5 BOROUGHS)

DISTRICTS 1-5 (NYC/5 BOROUGHS)

• Aetna (Blue Cross/Blue Shield) – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• Cigna – https://www.cigna.com/health-care-providers/credentialing/join-medical-network
• United Healthcare Oxford – https://www.oxhp.com/providers/sell/inthedetails/credentialing.html
• United Healthcare – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• Magnacare – https://www.magnacare.com/provider-resource-center/
• EmblemHealth (formerly known as GHI) – https://www.emblemhealth.com/providers/resources/join-our-network
• Hip/1199/MPN – https://www.emblemhealth.com/providers/resources/join-our-network

NYSCA REGION 2 (LONG ISLAND)

DISTRICTS 6 (NASSAU COUNTY) AND 7 (SUFFOLK COUNTY)

• Northwell UHC – separate credentialing
• United Healthcare – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• United Healthcare Oxford – https://www.oxhp.com/providers/sell/inthedetails/credentialing.html
• Empire Blue Cross/Blue Shield – Call 1-800-450-8753 and put in a request with the Provider Services department. They will submit your inquiry on your behalf, a representative will then contact you to complete credentialing
• Aetna – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• Magnacare – https://www.magnacare.com/provider-resource-center/
• Multi plan – CAQH
• GHI – https://www.emblemhealth.com/providers/resources/join-our-network
• HIP – https://www.emblemhealth.com/providers/resources/join-our-network
• Oscar
• Meritain health (uses Aetna network) – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• Humana major medical uses GHI network – https://www.emblemhealth.com/providers/resources/join-our-network
• Cigna – https://www.cigna.com/health-care-providers/credentialing/join-medical-network
• 1199 – https://www.emblemhealth.com/providers/resources/join-our-network

NYSCA REGION 3 (EASTERN NY)

DISTRICT 8 (WESTCHESTER COUNTY)
Coming soon

DISTRICT 9 (MID HUDSON)
Coming soon

DISTRICT 10 (CAPITAL REGION & NORTH COUNTRY)

• Aetna – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• Capital District Physician’s Health Plan (CDPHP)
• Wellcare
• Empire Blue Cross/Blue Shield – Call 1-800-450-8753 and send in a request with the Provider Services department. They will submit your inquiry on your behalf, a representative will then contact you to complete credentialing
• GHI – https://www.emblemhealth.com/providers/resources/join-our-network
• Cigna – https://www.cigna.com/health-care-providers/credentialing/join-medical-network
• United Healthcare – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• MVP Liberty Mutual

DISTRICT 11 (MOHAWK VALLEY/UTICA AREA)
Coming soon

NYSCA REGION 4 (WESTERN NY)

DISTRICT 12 (CENTRAL NY/SYRACUSE AREA)

• Empire
• Excellus Blue Cross/Blue Shield – CAQH as well as a contract application:
  https://provider.excellusbcbs.com/documents/53971/224488/Application+For+Practitioner+Enrollment.%20pdf/64b6b41d-9bf5-77ba-3bbb-a1e13fc96ddc?t=1554600988518
  
• MPN (Optum) – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• MVP – CAQH

DISTRICT 13 (BINGHAMTON AREA)
Coming soon

DISTRICT 14 (ROCKLAND COUNTY)
Coming soon

DISTRICT 15 (FINGERLAKES/ROCHESTER AREA)

• Aetna – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• MVP/Cigna – https://www.cigna.com/health-care-providers/credentialing/join-medical-network
• Well care
• Independent health
• United Healthcare – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• Empire Blue Cross/Blue Shield – Call 1-800-450-8753 and put in a request with the Provider Services department. They will submit your inquiry on your behalf, a representative will then contact you to complete credentialing

DISTRICT 16 (SOUTHERN TIER/CORNING AREA)

• Empire Blue Cross/Blue Shield – Call 1-800-450-8753 and put in a request with the Provider Services department. They will submit your inquiry on your behalf, a representative will then contact you to complete credentialing
• Aetna – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• United Healthcare – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• MVP/Cigna – https://www.cigna.com/health-care-providers/credentialing/join-medical-network

DISTRICT 17 (WESTERN NY/BUFFALO AREA)

• Aetna – https://www.aetna.com/health-care-professionals/join-the-aetna-network/how-to-apply.html
• American Specialty Health: CAQH
• Blue Cross Blue Shield of WNY: CAQH
• Empire Blue Cross/Blue Shield – Call 1-800-450-8753 and put in a request with the Provider Services department. They will submit your inquiry on your behalf, a representative will then contact you to complete credentialing
• CIGNA Empire – https://www.cigna.com/health-care-providers/credentialing/join-medical-network
• Evicore: CAQH
• Humana – CAQH
• Independent Health – CAQH
• MagnaCare – https://www.magnacare.com/provider-resource-center/
• Multiplan: CAQH
• MVP: CAQH
• Optum (ACN group and Managed physical network (MPN)) – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• United Healthcare – https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html
• Univera – CAQH

Note: This list may not be a fully comprehensive list of ALL Insurance companies in New York. For additional insurance companies see health.ny.gov.

https://proview.caqh.org/PR/Registration

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

New York State Of Health Insurance Policy (Nyship)

This is a state-run Medicaid program. By credentialing with Medicaid, you can choose to accept NYSHIP.

Note: Medicaid coverage for Chiropractic care varies depending on the provider. Some plans do not cover Chiropractic care.

WORKERS’ COMPENSATION COMMITTEE FAX COVER SHEET

• https://nysca.memberclicks.net/assets/docs/NYSCA_WC_Fax_Cover.pdf
• https://nysca.memberclicks.net/assets/docs/WC_Exacerbation_Documentation.pdf
• https://nysca.memberclicks.net/assets/docs/WC_Maintenance_Documentation.pdf

MEDICAL FEE SCHEDULE

• http://www.wcb.ny.gov/content/main/DistrictOffices/MainPage.jsp
• http://www.optum360coding.com/

MEDICAL TREATMENT GUIDELINES

• http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/Non-AcutePainMTG2014.pdf
• http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/MidandLowBackInjuryMTG2014.pdf
• http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/NeckInjuryMTG2014.pdf
• http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/FAQs.jsp
• http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/MTG_CategoriesOfTreatment.pdf

FREE ONLINE TRAINING

• http://www.wcb.ny.gov/content/main/hcpp/MedicalTreatmentGuidelines/Training/MTG_NonMed.jsp

IMPAIRMENT GUIDELINES (SCHEDULED LOSS OF USE)

• http://www.wcb.ny.gov/content/main/hcpp/ImpairmentGuidelines/2012ImpairmentGuide.pdf (Beginning on page 52)
• http://www.wcb.ny.gov/content/main/hcpp/ImpairmentGuidelines/ImpGuideOverview.jsp

NEW YORK STATE WORKERS COMPENSATION BOARD

• http://www.wcb.ny.gov/content/main/hcpp/hcpp.jsp
• http://www.wcb.ny.gov/content/main/Contact.jsp

AUTHORIZED PROVIDERS

• http://www.wcb.ny.gov/content/main/hcpp/AuthAppWebLinkInfo.jsp

WORKERS’ COMPENSATION FORMS

• http://www.wcb.ny.gov/content/main/forms/AllForms.jsp
• http://www.wcb.ny.gov/content/main/forms/Forms_HEALTH_PROVIDER.jsp

EMPLOYER/CARRIER INFORMATION

• https://www.wcb.ny.gov/MTGContact/MTGContactSearch.jsp?searchContacts=Search+for+Carrier+Contacts+and+Participation
• http://www.wcb.ny.gov/content/ebiz/icempcovsearch/icempcovsearch_overview.jsp

ON-LINE SERVICES

• https://www.wcb.ny.gov/DTNLookUp/DTNLookUp.jsp
• http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_HCProvider.jsp
• http://www.wcb.ny.gov/CMS-1500/
• http://www.wcb.ny.gov/content/ebiz/XMLSubmissions/xmlSubmissions_overview.jsp
• http://www.wcb.ny.gov/availability/availability.jsp

INFORMATIVE LINKS

• http://www.wcb.ny.gov/content/main/SubjectNos/subjectNos.jsp
• http://www.wcb.ny.gov/content/main/wclaws/newlaws.jsp
• http://www.wcb.ny.gov/content/main/TheBoard/BrdAnnouncements.jsp

ADDITIONAL QUESTIONS

• https://nysca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2020377#/

There is no formal participation application for No Fault. You will bill the insurance carrier. All forms below found at: https://www.nysca.com/no-fault (Must be a NYSCA member to access)

Note: For additional information reach out to your local NYSCA District representatives: https://nysca.memberclicks.net/index.php?option=com_mcform&view=ngforms&id=2020377#/

NO FAULT FORMS

• https://www.dfs.ny.gov/system/files/documents/2019/01/nofault_2.pdf
• https://www.dfs.ny.gov/system/files/documents/2019/01/nofault_3.pdf
• https://www.dfs.ny.gov/system/files/documents/2019/01/nofault_aob.pdf
• https://www.nysca.com/assets/docs/PracticeMgmtForms/DrLein.pdf

NEW YORK INSURANCE LAW

• https://www.nysenate.gov/legislation/laws/ISC/A51
• https://www.nysenate.gov/legislation/laws/ISC/A52

CIRCULAR LETTERS AND DEPARTMENT OPINIONS

• https://www.dfs.ny.gov/apps_and_licensing/property_insurers/nofault_reg68_opinions

REGULATION 83 – THE NO-FAULT FEE SCHEDULE

• https://www.dfs.ny.gov/apps_and_licensing/property_insurers/faqs_reg83_nofault_schedule

OTHER LINKS

• https://www.adr.org/
• https://home.arbfile.org/programs/ny-pip

Starting into Practice Guide: The Business Side of Chiropractic by NCMIC

https://www.startingintopractice.com/