General guidelines for chiropractic services include:

  • Prior authorization is required for all treatment extending beyond the initial evaluation
  • Physician referral does not waive prior authorization requirements

Submitting a Prior Authorization Request for Chiropractic Services

  • Access Claim Lookup to obtain claim number or status
  • Review the Utilization Review Guide to determine if prior authorization is required
  • Complete the UR-Chiro form
  • Fax the UR-Chiro and supporting documentation to: 701-328-3765 or 866-356-6433

Submitting a Prior Authorization Request for Palliative Care

For more information about services requiring prior authorization, please contact Utilization Review at 701-328-5990 or 888-777-5871.

Chiropractic Treatment includes additional information on requirements for chiropractic treatment.