Chiropractic insurance billing in Arkansas.

Medicare’s chiropractic rules are federal — the same in every state. Medicare Part B covers ONLY manual manipulation of the spine to correct a subluxation (CPT 98940–98942), and ONLY when the care is active or corrective — which you signal with the AT modifier. Maintenance care, exams, X-rays, and any therapies performed by a chiropractor are not covered, so a properly executed ABN is essential before non-covered services. The full federal rules are in our chiropractic Medicare billing guide.

Part B claims in Arkansas are processed by Novitas Solutions (JH) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your Arkansas claims are measured against.

A Arkansas chiropractic or multi-specialty practice spends most of its commercial billing day with: Arkansas Blue Cross and Blue Shield (USAble Mutual); UnitedHealthcare; Centene/Ambetter (Celtic); QualChoice/QCA Health Plan; Aetna;

Humana. Each has its own claim portal, fee schedule, and chiropractic medical-policy quirks.

Chiropractic benefits in Arkansas are frequently ‘carved out’ to delegated musculoskeletal/physical-health network managers, which changes WHERE claims, authorizations, and treatment plans go. The two dominant managers nationally – and present in Arkansas – are:

• American Specialty Health (ASH / ASHLink), which administers chiropractic, acupuncture and PT networks for large national carriers such as Aetna, Cigna, and various Anthem/Blue plans (claims, credentialing and visit authorizations route through ASHLink rather than the health plan directly); and
• Optum Health / Optum Physical Health (the former ACN Group / OptumHealth Physical Health / Managed Physical Network), which administers UnitedHealthcare’s chiropractic and outpatient-therapy network. As of 9/1/2024, UnitedHealthcare/Optum requires prior authorization through Optum Physical Health (via the UHC Provider Portal, ‘Physical Health’ PA type) for the chiropractic/PT/OT TREATMENT PLAN (not the initial eval) on Medicare Advantage and many commercial plans, using CMS Ch. 15, LCDs and InterQual criteria. Arkansas Blue Cross and Blue Shield (the largest in-state commercial payer) generally administers its own chiropractic benefit under its ‘Primary Coverage Criteria’ rather than delegating to ASH. For Arkansas Medicaid managed care, benefits flow through the PASSE entities and DHS fee-for-service rules. ALWAYS verify on the member’s card / via eligibility whether chiro is delegated to ASH or Optum before sending the claim or auth – misrouting is a top denial cause. (Delegation arrangements change by plan and year; confirm per member.)

What trips up chiropractic billing in Arkansas:

• Visit caps vary widely – Arkansas Blue Cross commercial plans commonly cap chiropractic at up to ~50 visits/calendar year, but many plans aggregate chiropractic with PT/OT/speech into a combined limit (often ~30 visits/contract year), so the chiro ‘allowance’ is smaller than it looks.
• Arkansas Medicaid is very restrictive: for beneficiaries age 21+, only manual spinal manipulation for subluxation is covered, limited to 12 visits per State Fiscal Year (July 1-June 30), with 2 diagnostic spinal x-rays/year counting against a $500 radiology limit; under-21 EPSDT has no visit cap. No prior auth is required, but an extension of benefits (Form DMS-671) must be requested within 90 days of the benefits-exhausted denial with documentation of medical necessity.
• Medical-necessity / maintenance-care rules: Arkansas Blue Cross applies ‘Primary Coverage Criteria’ and will deny care once the patient plateaus at a maintenance level (no functional improvement) – documented functional gains and a clear treatment plan/re-eval are essential.
• Modifier discipline: Medicare and most commercial plans require the AT modifier on active/corrective spinal manipulation (98940-98942), and Medicare covers ONLY spinal CMT (not exams, x-rays, or therapies billed by a DC, which are statutorily excluded and need GY/ABN handling); UHC/Optum now requires PA on AT-modifier manipulation.
• Auth routing: when chiro is delegated to ASH or Optum, the treatment plan and visit authorizations must go to that vendor, not the health plan – a frequent source of ‘no authorization’ denials. Arkansas does grant DIRECT (no-referral) access to chiropractors, but that does not waive a plan’s visit caps, medical-necessity criteria, or delegated-vendor authorization. (Plan-specific caps, criteria, and delegation change yearly – verify per member/plan; this is general guidance, not legal advice.)

No statewide statutory initial-filing deadline; the window is set by the provider’s contract with each commercial/private payer. In Arkansas the common contractual initial-claim filing window runs roughly 90-180 days from the date of service (some plans allow up to 12 months) – confirm the exact limit in each payer’s provider agreement.

Separately, Arkansas prompt-pay law governs how fast a payer must adjudicate/pay a CLEAN claim once received: under Ark. Code Ann. 23-63-107 a first-party claimant must be advised of acceptance or denial within 15 working days of receipt of proper proof of loss, and Insurance Rule 43 sets claims-handling standards (e.g., investigation generally completed within 45 days).

These prompt-pay rules bind the PAYER’s payment timing, not the provider’s filing window.

12 months (one calendar year) from the date of service. This is a federal limit under 42 CFR 424.44 and applies in Arkansas exactly as nationwide; claims filed after 12 months are denied (e.g., CO-29) absent a narrow CMS exception (administrative error, retroactive entitlement, Medicare Secondary Payer, or a declared disaster).

12 months (365 days) from the date of service. Arkansas Medicaid’s timely-filing policy (Section 302.000 of the provider manual) applies the federal 42 CFR 447.45 standard and states there are NO exceptions to the 12-month deadline.

The 12 months also applies to adjustments/resubmissions, dual Medicare/Medicaid claims, and retroactive-eligibility claims (claim still due within 12 months of the date of service).

Arkansas Workers’ Compensation Commission Rule 099.30 (Medical Cost Containment Program) does NOT set a fixed number of days for a provider to submit a medical bill to the carrier – there is no hard provider-side timely-filing deadline in the rule itself.

Practically, bills should be submitted promptly on the proper form (UB-04 / CMS-1500) per Rule 30. Rule 30 instead governs the CARRIER side: a carrier must pay an undisputed, properly submitted bill within 30 days of receipt or be assessed an 18% penalty (and must dispute/adjust or return an improper-form bill within set timeframes).

Note: the overall workers’-comp CLAIM (not the medical bill) must be filed with the Commission generally within 2 years of injury under Ark. Code Ann. 11-9-702; confirm bill-submission expectations with the specific carrier/TPA.

Arkansas has NO fixed statutory deadline by which a provider must submit auto/PIP (no-fault) or Med-Pay medical bills. Arkansas is an add-on no-fault state: Ark. Code Ann. 23-89-202 requires automobile policies to offer at least $5,000 in medical/hospital benefits for reasonable and necessary expenses INCURRED WITHIN 24 MONTHS of the accident.

Under Ark. Code Ann. 23-89-208, PIP benefits are ‘overdue’ if not paid within 30 days after the insurer receives reasonable proof of the amount of benefits – which sets the payer’s payment clock, not a provider filing cutoff. Practical norm: bill the PIP/Med-Pay carrier as soon as possible and keep expenses within the 24-month incurred window; after PIP exhausts ($5,000) or for liability/third-party claims, the provider typically bills the patient’s health insurance (subject to that payer’s timely-filing window) or asserts a claim/lien against any tort recovery, which is governed by the personal-injury statute of limitations.