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Effective October 1, 2018, WSI will implement a change to the window period allowed in the existing chiropractic pilot program. The pilot program currently requires a chiropractor to obtain authorization for all chiropractic treatment extending beyond the initial 6 visits.  Based on pilot program analysis and provider feedback, WSI will alter the program to extend the window period from 6 visits to 10 visits.

WSI defines the window period as a period of initial chiropractic treatment on a claim not requiring prior authorization.  For initial treatment with a date of service on or after October 1, 2018, each claim will have one window period, which will include:

  • 10 visits or 60 days of care, whichever comes first, including initial evaluation
  • Treatment of all body parts accepted on a claim
  • Up to two modalities per visit

For treatment occurring outside the window period, a chiropractor will need to complete the Utilization Review Chiropractic (UR-Chiro) form.  For window periods beginning prior to October 1, all treatment provided after the sixth visit will require prior authorization. For window periods beginning on or after October 1, all treatment provided after the tenth visit will require prior authorization. WSI will continue to require prior authorization for all palliative care.

If you have questions about this article, please send an email to wsipr@nd.gov.  To receive provider news, subscribe to our Email Updates list. 

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