The NYSCA is pleased to share a newly released educational resource from NGS Medicare designed to support providers in navigating Advance Beneficiary Notice requirements with greater clarity and confidence.

The NYSCA Insurance Committee (The NIC) remains in contact with NGS and several clearinghouses relative to the 2026 CMS updates which resulted in claim denials.  During our testing we discovered new issues impacting clearinghouses. 

The NYSCA Insurance Committee (The NIC) has just learned of a claims processing error impacting Traditional Medicare claims.  These processing errors have resulted in the denial of claims which appear to have been correctly submitted.  Members of The NIC have been in communication with several clearinghouses, EHR companies and NGS Medicare to both report the issue, and discuss the solution.  To learn more about these denials, how to prepare, and respond to ensure you claim is processed correctly, please log in to NYSCA.com

Medicare Updates

The 2026 Medicare Fee Schedule has been posted to the NGS Medicare website.

As discussed during the past year, the NYSCA Insurance Committee (The NIC) anticipated significant changes in insurance offerings and benefits, especially within the 2026 Medicare Advantage market. Some carriers no longer offer a Medicare Advantage benefit, discontinued their programs in numerous counties throughout the country or changed their offerings.

It has come to the attention of the NYSCA that some plan materials for certain 2026 Medicare Advantage (Part C) plans have included language that may appear confusing and contradictory.  We want to assure members that chiropractic spinal manipulation to correct a subluxation (active treatment) remains a covered service under all Medicare Advantage plans, consistent with Medicare Part B coverage.

ICD-10 applies to all parties covered by the Health Insurance Portability and Accountability Act (HIPAA), not just providers who bill Medicare or Medicaid. ICD10 diagnosis codes an updated every year. Improper coding will result in a claim denial. Remember, proper coding is essential for documentation, reporting and reimbursement.

National Government Services (NGS) wants to share with our providers an urgent issue that has been identified by the Centers for Medicare & Medicaid Services (CMS).

For additional information, please access this NYSCA Member's Only link:

Beginning 5/19/2025, there is a new mailing address for Medicare Part B claim submitters in Connecticut and New York (Upstate Counties and Queens). 

Last week Excellus BlueCross BlueShield and Univera Healthcare sent letters to their Medicare Advantage members receiving chiropractic care. The NYSCA Insurance Committee (NIC) has spoken with numerous NYSCA doctors regarding this notice and the impact on their practices.

If you participate with UnitedHealthcare / Optum you may have received notice of the change in the aforementioned prior authorization program.  Based upon the volume of calls, texts, and emails received by the NYSCA Insurance Committee (NIC), there has been several interpretations of the information published by UHC. For more information please access the following link:

UnitedHealthcare Updates

The 2025 Medicare Fee Schedule has been posted to the NGS Medicare website.

All Medicare providers and suppliers, including pharmacies, must not bill Medicare beneficiaries in the Qualified Medicare Beneficiary (QMB) eligibility group for Medicare Part A or Part B cost-sharing. This includes Medicare Part A and Part B deductibles, coinsurance, and copayments.

Read More: MLN Matters Fact Sheet October 2024

Starting today 11/18/2024, healthcare providers won’t have access to beneficiary eligibility information on the NGS Medicare interactive voice response (IVR) system. This includes all beneficiary eligibility information that was obtained under Option 1, Eligibility. The IVR will continue to offer the other non-eligibility transactions.

Beginning Jan. 1, 2025, the $15 copayment for the EmblemHealth-GHl portion of the Senior Care Plan will resume. Senior Care members will be required to pay a $15 copay each time they use the health services listed below. Copays are limited to one copay per provider per date of service.

Every year there are updates to the ICD-10 codes. Listed below please find the codes most relevant to the Chiropractic profession per the cms.gov website. These changes take effect 10/1/2024. 

Effective August 29, 2024, Humana is requiring prior authorization of certain Medicare Advantage members for chiropractic manipulative therapy rendered on or after August 29, 2024. The NYSCA Insurance Committee (NIC) reached out to Humana over the past week to ascertain whether prior authorization was required for Humana Medicare Advantage members in New York.

The NYSCA continues to communicate with Optum regarding the implementation of the new prior authorization program for AARP and UnitedHealthcare's Medicare Advantage members. We understand many of you have been attempting to determine the impact of this requirement on your practice and the patients you serve.  

On Thursday August 1st many of you received UnitedHealthcare's Provider News email.  That edition of Provider News included a section titled 'Outpatient therapy and chiropractic prior authorization required starting Sept. 1'.  Due to the lack of clarity in that email, the NIC reached out to several members of Optum's team Thursday morning and afternoon to obtain more specific information about the new requirement.