Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

PAP264

Chiropractic Quality Initiative Program


Provider Administrative Policy

Section
Ancillary Provider
Policy Date
July 2011
Status/Date
Revised/June 2012

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Chiropractic Quality Initiative Program

The Chiropractic Quality Initiative Program and its supporting quality improvement processes are designed and managed by Alternative Medicine Integration of Idaho (AMI) for Blue Cross of Idaho to continuously improve the quality of clinical care and services provided to our members from participating chiropractors.

Program Requirements

Effective September 1, 2011 providers are required to enter provider and patient data into the AMI Clinical Outcome Management System (ACOMSSM) on all current and future patient episodes of care.  Please gather the data via patient questionnaire(s) and provider treatment notification forms and enter it both at the initial patient visit and at monthly follow up evaluations for the duration of the episode of care. The intent of this program is to provide the chiropractic community and Blue Cross of Idaho a tool to compare specific chiropractic treatment patterns with nationally established, evidence base guidelines

To Access AMI's Quality Initiative Program Portal:

  • Go to: bcidaho.com
  • Select Providers
  • Log on using your username and password
  • Click on Chiropractic Management link

If you don't currently have access to bcidaho.com, please contact your external provider relations representative listed in (see PAP100).

For spinal related conditions as primary diagnosis, providers are required to utilize one or more the following provider and patient forms:

  • AMI Initial Provider Treatment Notification - Cervical & Thoraco-Lumbar (C&TL) Form or AMI Follow Up or Discharge Treatment Notification (C&TL) Form
  • AMI Initial Patient Pain Questionnaire or AMI Follow Up or Discharge Patient Pain Questionnaire
  • Oswestry or Neck Disability Index Questionnaire, depending upon the location of the primary complaint

For extremity related conditions as primary diagnosis, providers are required to utilize one or more of the following provider and patient forms:

  • AMI Initial Provider Treatment Notification - Upper Extremity & Lower Extremity (UE&LE) Form or AMI Follow Up Treatment Notification (UE&LE) Form
  • AMI Initial Patient Pain Questionnaire or AMI Follow Up or Discharge Patient Pain Questionnaire

Recommended Course of Treatment

Upon completion of entering the required data into ACOMSSM, both initially and on a monthly basis, providers will receive a recommended course of treatment based on the Official Disability Guidelines (ODG) Treatment Guidelines including:

  • Maximum number of recommended visits and duration of care
  • Detailed ODG Treatment Guideline for each diagnosis
  • AMI severity rated maximum number of recommended visits
  • Baseline outcome score for initial data submission and percentage improvement in outcome score for each follow up data submission

Blue Cross of Idaho and AMI will retrospectively compare the recommended course of treatment, and submitted claims. Analysis reports are then matched with the provider / patient episode of care in the ACOMSSM system. This report will show detailed information regarding how the care received compares to ODG Treatment Guidelines, and the percentage of services billed within and outside of ODG Treatment Guidelines. The report is available within the patient episode of care in the ACOMSSM system so your clinic can view or print it at any time. If an insured's condition is not improving based on a pre-determined minimal improvement standard, the ACOMSSM system will notify you after logging in to view the flagged episodes of care for lack of clinical improvement or excessive services outside of ODG Treatment Guidelines.

Chiropractic services that are not medically necessar may be submitted with a GA modifier once a signed ABN is obtained from the member. Such services will be member liability. (See PAP 248)

Lower Tier Group Quality Improvement Program

Chiropractors will receive notification of their network standing and instructions on how to access the claims analysis reports from the retrospective paid claims analyses on a bi-annual basis. Network standing is based upon the amount of paid claims outside of ODG Treatment Guidelines. AMI will assign providers with 40% or more of their total paid claims outside of ODG guidelines in the Lower Tier Group Quality Improvement Program; however, any Provider with less than $3,500.00 of paid claims outside of ODG guidelines will be automatically assigned to the Upper Tier Quality Improvement Group regardless of their percentage of paid claims within ODG guidelines.  AMI will work with the chiropractors to establish a targeted reduction in services outside of ODG guidelines. Education and peer coaching will be available to the chiropractors while in the Lower Tier Group. Blue Cross of Idaho may terminate contracting providers failing to meet targeted reductions at the next network review.

AMI of Idaho Contact Information

Providers may contact AMI of Idaho at (855-432-2667). AMI Provider Representatives will be happy to answer general questions about the Blue Cross of Idaho Chiropractic Quality Initiative Program. Specific questions regarding ACOMSSM  and ODG may be answered through the AMI portal of the Blue Cross of Idaho Website. The following Blue Cross of Idaho groups do not require patient documentation entry into ACOMSSM as described in this policy. Please refer to PAP 102 for a listing of groups and alpha prefixes for your reference.

  • Medicare Supplements
  • Medicare Advantage (True Blue and Secure Blue)
  • Federal Employee Program
  • BlueCard members
  • State of Idaho employees

When Blue Cross of Idaho is Secondary
Patient documentation is not required when Blue Cross of Idaho is the payer of secondary coverage. All services, whether primary or secondary, may be subject to medical necessity review.

Tax Identification Changes for Clinic
When a clinic changes their Tax Identification they must notify the appropriate Provider Representative. (See PAP230). This will ensure ACOMSSM System is flagged to merge the provider's login with all previous system entries.


Policy History

Date Action Reason
June 2012 Revised Added section regarding Tax Identification Changes for Clinic
September 2011 Revised Added excluded groups.

Search for Policies

Policy Feedback