Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Chiropractor Bulletin 3
February 1999

TO:      Chiropractors Participating in MassHealth

FROM:      Bruce M. Bullen, Commissioner

RE:      CHIROPRACTIC SERVICES TO MEMBERS ENROLLED IN MASSHEALTH MANAGED CARE ORGANIZATIONS

Background                       Effective July 1, 1998, the Division entered into new contracts with the following managed care organizations (MCOs).

w    Boston Medical Center HealthNet Plan
w    Fallon Community Health Plan
w    Harvard Pilgrim Health Care
w    Kaiser Permanente/Community Health Plan
w    Neighborhood Health Plan
w    Network Health

Before January 1, 1999, these MCOs were not required to provide the chiropractic benefit to their MassHealth MCO members.

Contract Change                Effective for dates of service on or after January 1, 1999, the MCOs listed above are responsible for providing chiropractic services to their MassHealth members.  In accordance with 130 CMR 450.105(A)(3)(a) and (B)(3)(a), the Division will not reimburse chiropractors for these MassHealth members enrolled in the MCOs listed above for any service provided on or after January 1, 1999.

Authorization and              Effective for any date of service on or after January 1, 1999, for members
Payment from MCOs          enrolled with a MassHealth MCO, chiropractors should seek authorization and payment from the member’s MCO.

Recipient Eligibility            In accordance with 130 CMR 450.107(C)(2), providers must check the
Verification System            Recipient Eligibility Verification System (REVS) to verify a member’s eligibility and covered benefits to ensure appropriate payment.

Questions                         If you have questions about the information in this bulletin, call the Unisys
Provider Services Department at (617) 628-4141 or 1-800-325-5231.