Chiropractic insurance billing in Colorado.

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 Colorado 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 Colorado claims are measured against.

A Colorado chiropractic or multi-specialty practice spends most of its commercial billing day with: Kaiser Permanente; Anthem Blue Cross Blue Shield; UnitedHealthcare / Rocky Mountain Health Plans; Cigna Healthcare; Denver Health Medical Plan;

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

Two delegated musculoskeletal/chiropractic network managers dominate in Colorado.

• American Specialty Health (ASH) administers chiropractic (and often acupuncture/PT/massage) benefits for several national plans operating in CO. Cigna delegates chiropractic/PT to ASH in Colorado — Cigna expanded its use of ASH into Colorado effective September 1, 2023 — and Anthem Blue Cross Blue Shield (the dominant Colorado Blues plan, an Elevance/Anthem company) administers chiropractic/acupuncture through ASH (‘ASH Plans’) on many products, with a typical combined chiro+acupuncture visit cap and treatment-plan pre-approval routed to ASH. ASH also historically serves Aetna and Health Net lines. When a plan delegates to ASH, network enrollment, prior auth/treatment-plan submission, and claims route to ASH (ashlink.com), NOT to the health plan.
• Optum / Optum Physical Health (UnitedHealth Group) manages chiropractic and outpatient therapy for UnitedHealthcare. UHC delegates Medicare-covered chiropractic review to Optum and, effective July 1, 2025, EXPANDED its Medicare Advantage prior-authorization requirement for chiropractic, PT, OT, and ST to UHC MA members in specific Colorado plans (the initial national rollout for MA chiropractic prior auth began Sept 1, 2024). Always verify on the member’s card/portal whether chiropractic is carved out to ASH or Optum, because that determines where authorizations and claims go.

What trips up chiropractic billing in Colorado:

• Carve-out routing is the #1 denial cause — Cigna and Anthem/BCBS chiropractic typically run through ASH (ashlink.com), while UnitedHealthcare runs through Optum; sending the claim or treatment-plan auth to the health plan instead of the delegated administrator gets it bounced. Confirm the delegated entity on the member’s card before submitting.
• Visit caps and treatment-plan/medical-necessity rules — ASH-administered plans (Anthem, Cigna) generally impose an annual visit limit (often ~20-30 visits, frequently a COMBINED cap shared across chiropractic, PT/OT, and sometimes acupuncture) and require the chiropractor to submit a treatment plan to ASH for approval, with periodic re-evaluation and a clear shift from active/corrective to ‘maintenance’ care (maintenance is typically non-covered). Cigna commonly applies a combined PT/OT/chiro hard cap.
• UHC/Optum MA prior auth — for Colorado MA members (expanded 7/1/2025), the initial evaluation does not need prior auth, but the treatment plan (which sets the number of visits) does; up to 6 visits in 8 weeks may be auto-approved for a new patient/new condition/90-day gap, with anything beyond going to medical-necessity review by licensed clinicians.
• Modifiers/pre-auth quirks — expect AT (active treatment) on Medicare/MA spinal manipulation (98940-98942), correct GA/GY/GZ and -59/-XU usage when distinct services are billed, and remember Medicare/MA covers ONLY manipulation (not exams, x-rays, or therapies done by the DC).
• Medicaid scope — standard Health First Colorado generally does NOT cover routine chiropractic for adults; chiropractic is available mainly through the Complementary and Integrative Health (CIH) HCBS waiver or other limited circumstances, so verify benefit/eligibility before treating a Medicaid member as a cash vs. covered visit.
• No broad Colorado statutory chiropractic ‘mandate’ equivalent to some states — coverage, caps, and self-referral rules are set by the plan/ASH, so read the EOC. Not legal advice — verify benefits and current rules per payer.

Largely contract/payer-set, not fixed by Colorado statute. The common initial-claim filing window for commercial/private payers runs roughly 90-180 days from the date of service (e.g., Cigna and many ASH-administered plans run ~90-120 days;

UnitedHealthcare and Anthem/BCBS commercial plans commonly ~90-180 days). Always confirm the exact deadline in your participating-provider agreement or the payer’s provider manual, since it can be shorter or longer by plan and product line.

Colorado context: C.R.S. 10-16-106.5 (the state ‘prompt pay’/clean-claim law) governs how fast the CARRIER must act on your claim — a clean claim must be paid, denied, or settled within 30 calendar days if submitted electronically (45 days if paper), with an outer limit of 90 days; late payment accrues 10% annual interest, and failure to resolve within 90 days adds a 20% penalty on the allowed amount.

That law sets the insurer’s PAYMENT clock, not the provider’s SUBMISSION deadline, which remains contractual.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service claim. This is set by the Social Security Act (Section 1842(b)(3)(B)) and CMS, not by Colorado. Medicare Advantage plans may set their own (often similar, up to ~12-month) deadlines — confirm per plan.

Note: for chiropractic, Medicare/MA covers only spinal manipulation (CPT 98940-98942) with the AT modifier for active/corrective care; UnitedHealthcare/Optum MA plans in Colorado now require prior authorization for Medicare-covered chiropractic (see payerNuance).

Health First Colorado (Colorado Medicaid): generally 365 days (one year) from the date of service to submit the INITIAL claim, even if that claim will deny, per the Department of Health Care Policy & Financing (HCPF) timely-filing rules and the General Provider Information Manual (and codified at 10 CCR 2505-10, Section 8.043).

After the initial timely-filing period, providers must RESUBMIT (or follow up on) the claim at least every 60 days to keep it within the timely-filing window, and the prior Internal Control Number (ICN) must be referenced on any claim over 365 days.

Waiting on prior authorization or on Department/fiscal-agent correspondence is NOT an acceptable reason for late filing. Health First Colorado RAE/managed-care entities (e.g., Colorado Access, regional accountable entities) and dental (DentaQuest) may apply their own contractor windows — confirm with the specific plan.

Colorado Workers’ Compensation: providers must submit medical bills within 120 days of the date of service or the bill may be denied, unless extenuating circumstances/good cause exist (e.g., delayed compensability decisions or not knowing where to send the bill), per Division of Workers’ Compensation Rule 16, 7 CCR 1101-3, Rule 16-8-2(A).

On the payer side, an accepted/clean bill is due and payable per the Medical Fee Schedule within 30 days after receipt, and the payer must reply with a written notice (EOB) within 30 days, unless the payer timely contests it for proper reasons (Rule 16-10(A)).

Colorado also mandates electronic billing acceptance for injured-worker treatment beginning January 1, 2026, but the 120-day timely-filing deadline is unchanged for paper or electronic bills.

Colorado has NO no-fault/PIP system (mandatory PIP was repealed effective 2003) and NO fixed statutory deadline for submitting medical bills to an auto carrier. The relevant first-party coverage is Medical Payments (Med-Pay): under C.R.S. 10-4-635, auto insurers must include at least $5,000 in Med-Pay on every policy unless the insured rejects it in writing.

Any bill-submission timeframe is set by the individual auto policy (commonly a 1-, 2-, or 3-year window), not by statute — submit promptly per policy terms. Once a clean Med-Pay claim is received, the insurer’s PAYMENT clock is governed by Colorado’s prompt-pay-of-direct-benefits law, C.R.S. 10-4-642 (generally 30 days electronic / 45 days paper, with escalating interest for late payment).

The underlying third-party liability/personal-injury claim is bound by Colorado’s 3-year auto statute of limitations (C.R.S. 13-80-101); on a liability/lien basis, bills are typically presented at settlement. Confirm each Med-Pay policy’s notice/submission terms.