New Jersey Department of Banking & Insurance (DOBI) Issues Decision in Administrative Action In Favor of Association of New Jersey Chiropractors Against Horizon

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An administrative action initiated by the Association of New Jersey Chiropractors (ANJC) and American Chiropractic Association (ACA), with the New Jersey Department of Banking & Insurance (DOBI) against Horizon Blue Cross Blue Shield of New Jersey concluded by the Department's recent ruling ordering Horizon to cease and desist from globally bundling Evaluation and Management (E&M) and Physical Therapeutic Services into Chiropractic Manipulative Treatment (CMT) Services. As a result, for these services chiropractors throughout the state can immediately begin filing reimbursement claims for these services which must be individually reviewed and reimbursed by Horizon rather than being denied across the board as was Horizon's previous policy.

Although this has taken a long time to come to fruition this is again another example of ANJC's ability to make a difference in how Doctors of Chiropractic will be able to practice throughout New Jersey.

An administrative action initiated by the Association of New Jersey Chiropractors (ANJC) and American Chiropractic Association (ACA), with the New Jersey Department of Banking & Insurance (DOBI) against Horizon Blue Cross Blue Shield of New Jersey concluded by the Department's recent ruling ordering Horizon to cease and desist from globally bundling Evaluation and Management (E&M) and Physical Therapeutic Services into Chiropractic Manipulative Treatment (CMT) Services. As a result, for these services chiropractors throughout the state can immediately begin filing reimbursement claims for these services which must be individually reviewed and reimbursed by Horizon rather than being denied across the board as was Horizon's previous policy.

DOBI Commissioner Neil N. Jasey issued his Decision & Order # A09-113 on October 7th with regard to this administrative action that ANJC and ACA initiated with the DOBI and tried several years ago.

Horizon was cited in the ruling by Commissioner Jasey for violating the Unfair Claim Settlement Act in regards to two key issues related to chiropractors not being properly reimbursed for E&M services and modalities/procedures.

  •     The Commissioner ruled that the global fee reimbursement policy of bundling E&M into CMT violates the Unfair Claim Settlement Act. "The fact that in other disciplines comparable services are billed separately and compensated separately is probative on the question of whether Horizon's blanket policy of including multiple services performed by a licensed chiropractor in a single visit in one "global fee" for CMT services is appropriate," said Jasey in the ruling
  •     The Commissioner also ruled that Horizon's global reimbursement policy regarding physical therapeutics violates the Unfair Claim Settlement Act. The Commissioner held that Horizon's global reimbursement policy regarding physical therapeutics violates the Unfair Claim Settlement Act. The Commissioner reasoned that some modalities are integral to CMT and not separately reimbursable (i.e. hot/cold packs). However, he also found that others are not and must be reimbursed separately.

"This ruling by Commissioner Jasey and DOBI is a testament to the unwavering support and dedication exhibited by ANJC's legal team, headed by Jeffrey Randolph Esq, to protect our doctors from being unfairly questioned on procedures that are totally legal and properly performed on patients throughout the state," said Dr. Sigmund Miller, ANJC executive director.

The decision was met by a sense of both gratitude and vindication from the 1500 strong-membership of the ANJC, which has been fighting what they felt to be unfair decisions by Horizon to deny these procedures. Over 500 ANJC members were briefed on the procedures for filing reimbursement claims during ANJC's annual convention this weekend at the Marriott Hanover in Whippany.

Added Miller: "Although this has taken a long time to come to fruition this is again another example of ANJC's ability to make a difference in how Doctors of Chiropractic will be able to practice throughout New Jersey."

About the Association of New Jersey Chiropractors
ANJC is one of the largest associations of chiropractors in the nation, with 1,500 members, statewide. ANJC's mission is to educate its members on the latest technology and advancements in the profession and to become a trusted, relied upon information resource to the public regarding the benefits of chiropractic care. For more information, please visit ANJC's public information website at http://www.njchiropractors.com or call (908) 722-5678.

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