Chiropractic insurance billing in New Hampshire.

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 New Hampshire are processed by National Government Services (JK) — its Local Coverage Determination and documentation expectations (and its audits of the AT modifier and medical necessity) are the ones your New Hampshire claims are measured against.

A New Hampshire chiropractic or multi-specialty practice spends most of its commercial billing day with: Anthem Blue Cross Blue Shield; Harvard Pilgrim Health Care; Cigna; Tufts Health Plan; WellCare (Centene); UnitedHealthcare. Each has its own claim portal, fee schedule, and chiropractic medical-policy quirks.

Two delegated musculoskeletal network managers dominate chiropractic in New Hampshire.

• American Specialty Health (ASH / ‘ASH Plans’, ashlink.com) administers chiropractic (and acupuncture) networks and medical-necessity/treatment-plan review for several major carriers operating in NH – notably Anthem Blue Cross Blue Shield of New Hampshire (chiropractic visits and medical necessity are determined by ASH Plans, with treatment plans submitted to ASH) and Cigna (Cigna delegates chiropractic/acupuncture network and clinical management to ASH, an arrangement Cigna has been expanding). ASH is confirmed active in New Hampshire.
• Optum (OptumHealth Care Solutions / Optum Physical Health, myoptumhealthphysicalhealth.com) administers chiropractic and physical-medicine networks and clinical review for UnitedHealthcare and historically Oxford. Practical impact: for ASH- or Optum-managed plans, network enrollment, the provider directory, prior authorization/treatment-plan submission, clinical review, and sometimes claims routing go through ASH or Optum – NOT directly to the health plan. Verify each patient’s plan to confirm whether chiropractic benefits are delegated and to which manager before submitting auths or claims.

Dominant NH commercial payers are Anthem BCBS NH (the largest, including the State of NH employee plans and Anthem HMO/POS New England networks), Cigna, Harvard Pilgrim / Point32Health, and UnitedHealthcare. Chiropractic gotchas:

• Visit caps – chiropractic is commonly capped per calendar year and is frequently COMBINED with acupuncture toward one shared maximum (e.g., Anthem plans commonly allow up to ~30 medically-necessary chiropractic-plus-acupuncture visits per calendar year as determined by ASH); always check the member’s specific benefit.
• Medical-necessity & treatment-plan review – for ASH-delegated Anthem and Cigna chiropractic, the chiropractor must submit a treatment plan to ASH for approval and ongoing visits hinge on ASH’s medical-necessity determination; re-evaluations and clinical updates drive continued authorization. ‘Medical Necessity’ is also defined by New Hampshire law.
• Routing – auths and often claims for ASH/Optum-delegated members go to ASH/Optum, not the carrier; sending them to the wrong entity causes denials/delays.
• Documentation, modifiers, and maintenance care – active-treatment documentation supporting medical necessity is essential; maintenance/wellness care is typically non-covered, and Medicare requires the AT modifier (active treatment) with proper documentation for the covered manual-manipulation CPT codes (98940-98942), with non-covered maintenance care flagged via GA/GZ as appropriate. New Hampshire does not impose a broad state-mandated commercial chiropractic benefit, so coverage scope is set by each plan. The most common NH chiropractic billing failures: exceeding the shared visit cap, missing/expired ASH or Optum treatment-plan authorization, sending claims/auths to the carrier instead of the delegated manager, and the short 120-day Medicaid-MCO filing window.

Largely contract/payer-set, not fixed by New Hampshire statute. The common initial-claim filing window for commercial/private payers runs roughly 90 to 180 days from the date of service (e.g., many plans use 90, 120, or 180 days; some allow up to 12 months).

Always confirm the exact limit in the specific payer agreement, provider manual, or member plan, because it varies by payer and product. New Hampshire’s prompt-pay law (RSA 415:6-h, RSA 415:18-k, RSA 420-A:17-d and N.H. Admin. Code Ins 3601.31) governs how fast a payer must adjudicate a clean claim once filed – generally 15 calendar days for a clean electronic claim and 30 calendar days for a clean paper claim, with 1% per month interest on late payment – but it does NOT set the provider’s filing deadline.

As of 2025-2026; confirm per payer.

Federal limit: 12 months (one calendar year) from the date of service, per Section 6404 of the Affordable Care Act and 42 CFR 424.44. This applies in New Hampshire as in every state (Medicare Part A/B is administered for New Hampshire by the MAC, National Government Services / Jurisdiction K).

Claims filed after one year are denied and that denial is generally not appealable except for narrow CMS-defined exceptions (administrative error, retroactive eligibility, etc.).

New Hampshire Medicaid fee-for-service (FFS): generally one year (12 months) from the date of service to submit an initial claim, with a Timely Filing Override process for claims that were filed timely but denied (per the NH Medicaid General Billing Provider Manual / NH MMIS).

IMPORTANT: the three NH Medicaid managed care organizations (MCOs) are much shorter – AmeriHealth Caritas NH, NH Healthy Families (Centene), and WellSense Health Plan all use 120 calendar days from the date of service for initial claims (and typically 120 days from the primary payer’s disposition for coordination-of-benefits/secondary claims; corrected claims often 365 days).

Most NH Medicaid members are enrolled in an MCO, so the practical deadline for most Medicaid claims is 120 days, not one year. Confirm per plan. As of 2025-2026.

New Hampshire Workers’ Compensation: the treating provider must file the NH Workers’ Compensation Medical Form (Lab 500 series) with the workers’ comp carrier within 10 days of treatment (first aid excluded), per N.H. Admin. Code Lab 506/508.

Failure to file the required medical form can result in the provider not being reimbursed and a civil penalty of up to $2,500. (Separately, the carrier must pay or deny a medical bill within 30 days of receipt under Lab 506.02.) Note: the underlying injured-worker claim has a 3-year statute under RSA 281-A:48-a, but for medical-bill/medical-form submission the operative timeframe is the 10-day medical-form rule.

Confirm current Lab 500 rule version.

New Hampshire has NO fixed statutory deadline for submitting auto medical bills (no-fault/PIP-style filing deadline). New Hampshire is an at-fault (tort) state and does not have true no-fault PIP; instead, auto policies issued in New Hampshire must include at least $1,000 of Medical Payments (Med-Pay) coverage under RSA 264:16, and those benefits are non-subrogable under RSA 264:17.

Bill submission timeframes for Med-Pay are set by the auto policy/contract, not statute – practical norm is to submit promptly (often within the policy’s ‘as soon as reasonably possible’ notice/proof-of-loss terms). For bills paid out of a third-party (at-fault) liability claim, there is no per-bill filing deadline, but the underlying personal-injury claim is governed by New Hampshire’s 3-year statute of limitations (RSA 508:4).

Confirm per policy.