Update to a Rolling Calendar Year for Calculating Chiropractic Services

Date: 03/16/22

As previously outlined in two prior Iowa Total Care Provider Alerts (dated March 12, 2020 and January 26, 2021), Iowa Total Care made changes to authorization requirements for chiropractic services for members. The Provider Alerts were based on the Department of Human Services Informational Letter 2060. Informational Letter 2060 outlines the number of chiropractic services allowed per diagnosis that will not require a notification or prior authorization.

Iowa Total Care was using a calendar year to calculate chiropractic services received by a member. The Iowa Medicaid Enterprise has directed managed care organizations to use a rolling calendar year instead of calendar year to calculate the number of visits.

As a result of this decision, all members’ chiropractic visits reset to 0 (zero) as of January 1, 2022. The rolling calendar year will start when the member starts their chiropractic care after that time.

Note: This information is applicable to in-network providers only. If chiropractic services are needed beyond what is allowed in the Iowa Department of Human Services Information Letter 2060, a prior authorization request and clinical information should be submitted to Iowa Total Care for medical review. All chiropractic visits require authorization for out-of-network providers.

For questions or concerns, contact your Provider Relations Specialist or call Provider Services at 1-833-404-1061.