A pair of associations representing state and national chiropractors is cheering a decision by the New Jersey Department of Banking and Insurance over reimbursements for their services.

DOBI Commissioner Neil N. Jasey issued an order Oct. 7 calling for Horizon Blue Cross Blue Shield of New Jersey to cease and desist from bundling evaluation and management (E&M) and physical therapeutic services into chiropractic manipulative treatment (CMT) services.

The Association of New Jersey Chiropractors (ANJC) and American Chiropractic Association (ACA) said the result is that chiropractors throughout the state can immediately begin filing reimbursement claims for these services that will be individually reviewed by Horizon. Previously, the insurer’s policy called for a universal denial of the claims.

Dan Emmer, a spokesman for Horizon, told IFAwebnews.com the insurer has received the DOBI decision and is “in the process of reviewing and analyzing the ruling.”

Dr. Sigmund Miller, ANJC’s executive director, said his group and the ACA sought a decision by state regulators after years of trying to overturn the practice. Miller, in a statement, credited the “unwavering support and dedication” by the ANJC legal team “to protect our doctors from being unfairly questioned on procedures that are totally legal and properly performed on patients throughout the state.”

In the order by Jasey, Horizon was cited for two violations of New Jersey’s Unfair Claim Settlement Act.

Bundling E&M claims into CMT violates the act, Jasey said, “the fact that in other disciplines comparable services” are billed separately and not under one “global fee” for CMT services.

“Horizon cannot categorize and pay each and every claim for CMT and these other services in the same manner, regardless of the medical necessity for the services provided for which the claim is submitted,” Jasey wrote in his opinion. “Rather it must perform a reasonable investigation of the claim including and evaluation of the justification submitted by the Doctor of Chiropractic in support of the claim. Horizon should have evaluated each claim individually.”

Horizon also violated the act through its global reimbursement policy regarding physical therapeutics, Jasey said, as some modalities are integral to CMT and not separately reimbursable, such as hot/cold packs. Jasey also found that others are not and must be reimbursed separately.

In a statement, the ANJC said the decision was met by “a sense of both gratitude and vindication” by its 1,500 members who have fought Horizon on the issue for several years.

“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,” Miller said.

The ANJC is also currently involved, along with the New York Chiropractic Council, in a class-action suit against Aetna over “abusive practices,” including pre- and post-payment auditing the groups say violates federal laws.