Web page link

https://utahchiropracticphysiciansassociation.org/

Membership Fees

May be billed quarterly to monthly, as well.

Member benefits

• CEUs
• Access to advisors in accounting, PI, marketing, finance, law, etc.
• Mentorship program
• Classifieds
• Directory
• $0 towards cost of spring and fall conventions

Website to apply for license:  https://dopl.utah.gov/chiropractic-physician/  

• $200 application fee
• Jurisprudence exam scheduled through Provexam.com
  • $68 exam fee
  • 30 questions on Utah state laws and rules
  • Passing: 75%
• Fingerprinting and background check not required

NBCE Requirements:

Parts I*, II*, III* and IV*, PT: Required – PASSING SCORE IS 375

NBCE Acupuncture accepted.

NBCE SPEC may be required in individual circumstances.

STATE SCOPE OF PRACTICE:

Contact State for precise definition by state law.

A practice of the healing arts, the purpose of which is to restore or maintain human health, in which patient-care, or first aid, hygienic, nutritional, or rehabilitative procedures are administered, and which places emphasis upon specific vertebral adjustment, manipulation and treatment of the articulation and adjacent tissues of the spinal column and musculoskeletal structure of the body and nervous system. A chiropractor may examine, diagnose and treat only within this scope, and may not perform “incisive” surgery, prescribe or administer drugs, or medicines for which an authorized prescription is required by law, treat cancer, practice obstetrics, prescribe or administer X-ray therapy or set displaced fractures. A chiropractor may use X-ray for diagnostic purposes only.

Synopsis taken from FCLB.org

CONTINUING EDUCATION:

• $103 renewal fee, biennially on May 31 of even years
• 20 hours per year (40/renewal), 5 distance hours allowed per year
• Accepts 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

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 – https://www.chirosecure.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.

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. 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

Common insurance companies include Aetna, American HealthPlans, Anthem, Cigna, Select Health, U Health Plans, UHC (Optum)

Aetna: https://www.aetna.com/health-care-professionals/join-the-aetna-network.html 

American HealthPlans: https://amhealthplans.com/ 

Anthem: https://www.anthem.com/provider/credentialing/ 

Cigna: https://www.cigna.com/health-care-providers/credentialing/join-medical-network 

Molina Health: https://www.molinahealthcare.com/providers/ut/medicaid/home.aspx 

Select Health: https://selecthealth.org/providers/join-our-networks/utah 

U health plans: https://uhealthplan.utah.edu/providers/credentialing 

UHC (viaOneHealth) https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html

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

• Utah Provides services
  • Coverage for women and EPSDT eligible members age 6 and up
  • EPSDT: early periodic screening diagnosis treatment eligible children age 6 and up
• Coverage for evaluations and therapy/service sessions
• 12 visits per calendar year
  • Additional visits require written prior authorization

Provider manual: https://medicaid.utah.gov/Documents/manuals/pdfs/Medicaid%20Provider%20Manuals/Archives/Chiropractic%20Medicine%20%28Archived%20October%202017%29/Archive/2015/ChiropracticMedicine10-15.pdf

Covered as a reasonable and necessary medical benefit

Handbook and guidelines: https://www.laborcommission.utah.gov/wp-content/uploads/2024/04/Current-Impairment-Rating-Guide-Effective-May-05-2024.pdf