Chiropractic insurance billing in Nevada.

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 Nevada are processed by Noridian Healthcare Solutions (JE) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your Nevada claims are measured against.

A Nevada chiropractic or multi-specialty practice spends most of its commercial billing day with: UnitedHealthcare; Anthem Blue Cross Blue Shield; Aetna; Health Plan of Nevada (Sierra/UnitedHealth); Hometown Health; Prominence Health Plan.

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

Chiropractic and physical-medicine benefits in Nevada are frequently ‘carved out’ and delegated to specialty network managers, which changes where claims, authorizations, and credentialing go. American Specialty Health (ASH / ASHLink) is the dominant delegated chiropractic-PT manager: in Nevada it is delegated by Anthem Blue Cross Blue Shield of Nevada (commercial;

ASH handles network, credentialing, utilization management and claims, with medical-necessity review typically required starting at the 6th visit), by Cigna (delegated for network management, credentialing, UM/medical-necessity review and claims), and by Aetna in many markets.

When a member’s plan is ASH-delegated, chiropractic claims and authorizations go to ASH (not the health plan directly) and follow ASH’s clinical and filing rules. By contrast, Health Plan of Nevada / Sierra Health and Life (UnitedHealthcare-owned) and UnitedHealthcare commercial route chiropractic/musculoskeletal management through Optum / UnitedHealthcare’s own physical-health program (Optum uses InterQual criteria), not ASH.

Note: Anthem’s separate vendor Carelon Medical Benefits Management (formerly AIM Specialty Health) handles imaging/advanced-modality prior auth, which is distinct from ASH’s chiropractic network. Always verify on the member’s ID card / eligibility response whether chiropractic is delegated (e.g., an ASH logo or ‘ASH Plans’ notation) before submitting.

What actually trips up chiropractic billing in Nevada:

• Delegation confusion – for Anthem, Cigna, and many Aetna members, chiro claims and auths must go to ASH, not the health plan; sending them to the wrong place causes denials and blown timely-filing windows.
• Visit caps and medical-necessity review – ASH-delegated plans commonly cap chiropractic visits (often around 12-20 per year, plan-dependent) and require ASH medical-necessity review/treatment-plan submission once initial visits are exhausted (frequently from the 6th visit). UHC/Optum plans now allow up to the first 6 visits of an initial plan of care without clinical review when delivered within 8 weeks (Medicare Advantage change effective Jan 13, 2025), but require prior authorization for the full plan of care beyond that.
• Treatment-plan / re-eval documentation – delegated plans expect a documented treatment plan, measurable functional goals, and periodic re-evaluation to justify continued care; thin notes are the top cause of medical-necessity denials.
• Modifier discipline – Medicare and most commercial payers require the AT modifier on active/corrective spinal manipulation (98940-98942) and proper use of modifier 25 (separate E/M) and 59/XS (distinct therapy services) to avoid bundling denials; Medicare covers ONLY spinal CMT (98940-98942) and denies chiro-billed exams, x-rays, and therapy as non-covered.
• Nevada Medicaid – chiropractic is covered ONLY for children under 21 via Healthy Kids/EPSDT (PA not required for 4 or fewer visits per rolling 12 months; PA required beyond that and for code 97140); adult Medicaid chiropractic is not covered, so adult claims will deny.
• There is no Nevada state mandate forcing commercial plans to cover chiropractic, so coverage, caps, and carve-outs are entirely plan-specific – verify benefits and the delegated network for every patient.

Commercial/private-payer initial-claim filing windows in Nevada are NOT set by state law; they are set by your participation contract with each payer, so they vary. The common range is roughly 90-180 days from the date of service.

Notably, several dominant Nevada payers default to a tight 90-day window: UnitedHealthcare commercial and Aetna both publish a 90-day initial-filing limit (contract may negotiate longer, e.g., 120 days), and chiropractic claims routed through American Specialty Health (ASH) follow ASH’s own contract window.

Separately, Nevada’s prompt-pay / clean-claim law (NRS 683A.0879 and parallel sections, as amended by AB52 in the 2025 Legislature) governs the PAYER side, not the provider’s filing deadline: insurers/administrators must approve or deny a clean claim within 21 calendar days if submitted electronically or 30 calendar days if submitted on paper, then pay approved claims within that window or owe interest.

Bottom line: confirm the exact initial-filing deadline in each payer/network contract, as 90 days is a realistic worst case in this market.

12 months (one calendar year) from the date of service. This is a federal Medicare rule (Social Security Act 1842(b)(3); 42 CFR 424.44) and applies uniformly in Nevada through the Part B MAC (Noridian Healthcare Solutions, JF). State it plainly: claims must reach Medicare within one year of the DOS or they are denied as untimely (limited exceptions only).

180 days from the date of service (or the date of the eligibility decision, whichever is later) for in-state providers. The window is 365 days for out-of-state providers or when a third-party resource (other insurance) exists. Source:

Nevada Medicaid Web Announcement 2531 (June 25, 2021) and the Billing Manual for Nevada Medicaid and Nevada Check Up, Chapter 7. The timely-filing (stale-date) period is NOT extended on appropriately denied claims. Note a major chiropractic-specific limitation:

Nevada Medicaid covers chiropractic only for eligible children under age 21 (via Healthy Kids/EPSDT screening) and only spinal manipulation CPT 98940-98942 plus therapy 97110/97140 – adult chiropractic is not a covered Nevada Medicaid benefit (Provider Type 36 Billing Guide).

90 days after the date of service (extendable up to 12 months for good cause shown). Basis: NRS 616C.136 and the Nevada Medical Fee Schedule, as summarized in the Division of Industrial Relations (DIR) Workers’ Compensation Section ‘Claims Processing Time Frames’ chart.

The insurer then has 45 days to approve or deny the bill. Late submission can trigger penalties. Do not confuse this with the separate C-4 ‘Report of Initial Treatment,’ which the treating physician/chiropractor must file with the employer and insurer within 3 working days of treatment (NRS 616C.040).

Nevada has NO fixed statutory deadline for a provider to submit a medical bill to an auto carrier. Nevada does not mandate PIP; Personal Injury Protection / Medical Payments (Med-Pay) coverage is optional, so when it exists the bill-submission/notice terms are set by the individual auto policy (commonly ‘as soon as reasonably possible’/within a reasonable time, often 30-90 days under policy language – confirm per policy).

For third-party (at-fault/liability) claims, there is no provider filing deadline, but the injured person’s underlying claim is bound by Nevada’s 2-year personal-injury statute of limitations (NRS 11.190), which practically caps how long bills can be pursued.

Bottom line: there is no single MVA deadline – it is policy- and claim-type-specific; verify the auto policy’s proof-of-loss/notice provisions.