Chiropractic insurance billing in North Dakota.

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

A North Dakota chiropractic or multi-specialty practice spends most of its commercial billing day with: Blue Cross Blue Shield of North Dakota; Sanford Health Plan; Medica; UnitedHealthcare; Aetna; Medicaid (ND Health and Human Services).

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

North Dakota is a comparatively LOW-delegation chiropractic market: the two dominant commercial payers manage chiropractic largely IN-HOUSE rather than carving it out to a national specialty-network manager.

• Blue Cross Blue Shield of North Dakota (BCBSND) — the state’s largest carrier and a nonprofit Blue plan — publishes and administers its own chiropractic reimbursement policy and prior-authorization rules directly (no evident American Specialty Health/ASH or Fulcrum delegation for BCBSND chiropractic as of 2025-2026); claims and policy questions go to BCBSND, not a third-party chiro network.
• Sanford Health Plan (Sanford is the dominant integrated health system in eastern ND, also administering the ND Medicaid Expansion program and serving NDPERS lines) likewise manages chiropractic within its own plan rules and visit limits.
• UnitedHealthcare members in ND follow UHC’s national pattern: chiropractic/outpatient-therapy network and Medicare Advantage prior authorization are managed through Optum / Optum Physical Health (entered via the UnitedHealthcare Provider Portal, adjudicated in Optum systems) — effective for MA, UHC delegates initial authorization and concurrent review for Medicare-covered chiropractic to Optum (initial eval generally exempt; routine/maintenance excluded).
• American Specialty Health (ASH) operates nationally and administers chiropractic/PT/acupuncture for several national carriers (Cigna and certain Aetna/Anthem/Health Net product lines), so an out-of-state-administered or national-employer plan presenting in ND may still route chiropractic to ASH (ashlink.com) even though the home-state Blue plan does not. BOTTOM LINE: always verify on the member’s ID card/portal whether chiropractic is handled by the health plan directly (typical for BCBSND and Sanford) or carved out to Optum (UHC) or ASH (some national plans), because that determines where credentialing, prior auth/treatment-plan submission, and claims go; misrouting is a leading denial cause. Workers’-comp chiropractic in ND goes exclusively through WSI; auto/PIP through the member’s no-fault carrier.

What actually trips up chiropractic billing in North Dakota:

• North Dakota has a chiropractic MANDATORY-OFFER (not a mandated-benefit) statute — N.D.C.C. 26.1-36-06 requires group health insurers/health-service corporations to MAKE AVAILABLE, at the policyholder’s option and for an additional premium, coverage of ‘services rendered and care administered by chiropractors licensed under chapter 43-06.’ So chiropractic coverage is offered but not universally required; verify whether the specific group elected it.
• Freedom-of-choice protection — N.D.C.C. 26.1-36-12.1 voids any health-service-corporation contract provision denying the insured the right to consult or employ any licensed doctor ‘including doctors of chiropractic,’ and the insurer must recognize a proof of claim duly certified by that doctor (a self-referral/anti-discrimination lever, not a benefit mandate).
• Utilization-review leverage — N.D.C.C. 26.1-36-41 bars a plan from sanctioning, terminating, or designating a practitioner (expressly including a chiropractor) as non-payable for an ‘excessive or inappropriate practice pattern’ without written notice, a not-less-than-six-month cure period, and a hearing before a committee that includes a representative of the practitioner’s specialty — useful against profiling-driven denials.
• BCBSND coding rules are strict on medical necessity: the PRIMARY diagnosis must be SUBLUXATION (stated, or by a descriptive term), with the specific level identified; a pain-only diagnosis or vague ‘all spinal’/’all affected’ regions will be rejected; covered CMT is 98940-98943, with 97140 (manual therapy) allowed only with distinct documentation; modifier -25 is required for a separately identifiable E/M; and for ND Medicaid Expansion (administered via BCBSND), the AT modifier must be appended to CMT codes 98940-98943 (effective June 15, 2026).
• ND MEDICAID fee-for-service has hard, state-specific chiropractic limits (ND Medicaid Chiropractic Services policy, updated Jan. 2026): coverage is 20 spinal manipulations (98940-98942) per CALENDAR YEAR (one per day) WITHOUT a service authorization, subluxation must be the PRIMARY diagnosis using an M99.0x code with the ABK qualifier and a neuromusculoskeletal SECONDARY diagnosis with the ABF qualifier, and — critically — the AT modifier is REQUIRED on every CMT code (CMT billed WITHOUT -AT is denied as non-covered; omit -AT to flag maintenance, which is non-covered). ND Medicaid also denies continued chiropractic care if no improvement is documented after the initial two weeks (unless treatment is modified) or within 30 days even with modification, or once maximum therapeutic benefit is reached; spinal x-rays are limited to 2 units per region per year and established-patient E/M (99211-99213) to 5 per year; bill on CMS-1500/837p within the 180-day window.
• Medicare/MA chiropractic in ND follows the national rule (manipulation-only with AT; Optum prior auth for UHC MA).
• WSI (workers’ comp) chiropractic is subject to WSI utilization review/prior authorization and its own fee schedule — not the commercial rules. Not legal advice — verify benefits and current rules per payer.

Largely CONTRACT/PAYER-SET, not fixed by a single North Dakota statute — the initial-claim filing window is whatever the participating-provider agreement or the payer’s provider manual specifies. In practice North Dakota commercial/private payers commonly use a 90-180 day window from the date of service (some plans allow up to 12 months); always confirm the exact number in your contract or the payer’s provider manual.

North Dakota does NOT set a minimum provider-submission floor, but its insurance code does regulate the policy’s claim mechanics and how fast the PLAN must act: under the standard accident-and-health policy provisions (N.D.C.C. 26.1-36-04(1)(g) and (i)), policies must allow written NOTICE of claim within 20 days of the loss and written PROOF OF LOSS within 90 days of the date of loss (failure does not bar a claim if it was not reasonably possible to comply, and in no event later than one year except where the claimant lacks legal capacity) — these are policyholder/claimant timelines, not your participating-provider submission deadline.

Separately, the North Dakota prompt-pay law (N.D.C.C. 26.1-36-37.1) requires the insurer, within FIFTEEN BUSINESS DAYS after receiving a health-insurance proof-of-loss form, to pay the uncontested portion, deny, or make an initial request for additional information; and within fifteen business days of receiving the requested information, to pay or deny.

That sets the insurer’s PAYMENT clock, not the provider’s SUBMISSION deadline, which remains contractual. As of 2025-2026; verify per payer and contract.

Federal limit: generally 12 months (one calendar year) from the date of service to submit an initial Medicare fee-for-service claim. Set by the Social Security Act (Section 1842(b)(3)(B)) and CMS (Medicare Claims Processing Manual, Ch. 1), not by North Dakota.

Medicare Advantage plans set their own deadlines (often similar, up to ~12 months) — confirm per plan. Note for chiropractic: Medicare/MA covers ONLY manual spinal manipulation to correct a documented subluxation (CPT 98940-98942) with the AT modifier on active/corrective-care claims; the chiropractor’s exams, x-rays, extraspinal manipulation (98943), and therapy modalities are NOT covered, and UnitedHealthcare/Optum MA now requires prior authorization for Medicare-covered chiropractic beyond an initial allowance.

North Dakota Medicaid: ND Medicaid must RECEIVE an original Medicaid PRIMARY claim within ONE HUNDRED EIGHTY (180) DAYS from the date of service, per the ND Medicaid Billing and Policy Manual (Timely Filing, updated Oct. 2025) implementing N.D.

Admin. Code 75-02-05-04.7. Key variations to know: (a) original SECONDARY/TERTIARY (third-party-liability) claims must be received within 365 DAYS from the date of service; (b) original MEDICARE CROSSOVER claims must be received within 180 DAYS from the date on the Medicare EOB (and providers must wait 60 days from the Medicare EOB date before submitting a crossover that did not auto-cross);

(c) RECONSIDERATION claims (replacement, resubmission, or void) may be filed within 365 DAYS of the date of service IF original timely-filing was met — and the original TCN and remittance-advice (RA) date must be entered in the claim notes as proof.

Timely filing may be extended for retroactive member or provider eligibility (generally 180 days from the determination/authorization date), and an adjustment from Medicare or a third-party payer dated after the ND Medicaid filing period gives 180 days from that adjustment notice.

ND Medicaid does NOT accept the provider’s own computer-generated reports (or previously timely-denied claims) as proof of timely filing; a Timely Filing Override Request Form exists for limited exceptions. Tracking is by the date ND Medicaid receives the claim.

NOTE: Medicaid Expansion is administered through a contractor (BCBSND) and may differ — confirm its manual.

North Dakota Workforce Safety & Insurance (WSI) is the state’s EXCLUSIVE, monopolistic workers’-comp fund (no private WC carriers). A medical provider must submit a bill to WSI within ONE YEAR (365 days) of the date of service, OR within one year of the date WSI accepts liability if WSI had not yet made — or reversed — a liability decision, per N.D.

Admin. Code 92-01-02-45.1 (Medical service provider responsibilities and billings) under N.D.C.C. Title 65. Bill on the current CMS-1500 or UB-04 (or the corresponding electronic version); since July 1, 2021, WSI no longer accepts paper bills except from providers submitting fewer than 50 bills/year, routing EDI through its exclusive clearinghouse vendor (Carisk Intelligent Clearinghouse).

If WSI has not accepted compensability and the provider bills the employee or another insurer in the interim, the provider must refund them and bill WSI once the claim is allowed. Chiropractic, therapy, and work-hardening/conditioning are subject to WSI utilization review/prior-authorization rules (a short extension of an existing authorization can be requested from WSI Utilization Review).

Confirm the current rule and the Prior Authorization Guide before relying on these.

North Dakota IS a no-fault auto state. Under the Auto Accident Reparations Act (N.D.C.C. ch. 26.1-41), basic no-fault / personal injury protection (PIP) pays an injured insured’s economic loss (medical expenses, work loss, etc.) up to a statutory limit (commonly cited at $30,000) regardless of fault. There is NO fixed statutory number-of-days deadline requiring a provider to SUBMIT medical bills to the no-fault carrier. Instead:

• basic no-fault benefits are ‘overdue’ if not paid within 30 DAYS after the insurer receives reasonable proof of the fact and amount of the loss (N.D.C.C. 26.1-41-13 area) — an insurer PAYMENT clock, not a provider submission deadline; and
• the outer limit is the limitation of actions in N.D.C.C. 26.1-41-19: if no no-fault benefits have been paid, an action for benefits must be commenced no later than 2 years after the injured person suffers the loss and knows (or should know) it was caused by the accident, or 4 years after the accident, whichever is earlier; if benefits have been paid, no later than 4 years after the last payment. Practical/contractual norm: submit bills to the PIP carrier promptly and on a rolling basis as services are rendered, and give notice of the claim early. The underlying third-party liability (tort) claim is governed by North Dakota’s separate 6-year personal-injury statute of limitations (N.D.C.C. 28-01-16). Confirm the specific policy’s notice/submission terms.