Significant no-fault and personal injury exposure, which puts the auto carrier ahead of the health plan in states that run PIP. In West Virginia that plays out against a specific set of rules rather than a general one.
Claims for West Virginia providers are adjudicated by Palmetto GBA (JM), which is also who hears the first level of appeal — so an appeal argument that works here works in every state that contractor covers.
At a glance
Coding driver
Active treatment versus maintenance care — the distinction every review examines and the record has to make.
Medicare contractor
Palmetto GBA (JM)
Medicaid program
Mountain Health Trust
Auto injuries
Tort state — health plan sequencing applies
What changes in West Virginia
Medicaid in West Virginia runs as Mountain Health Trust and is delivered largely through commercial managed care plans, so most Medicaid claims are adjudicated by an insurer with its own filing window and its own authorization rules rather than by the state.
Where chiropractic claims fail
- Care characterized as maintenance rather than active treatment
- Missing initial evaluation supporting necessity
- Auto claims billed to the health plan first
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your West Virginia chiropractic denials.
Scope
A written scope and price before any work starts.
Transition
Coding and submission move across without a gap.
Report
Denial causes segmented by payer and provider.
Chiropractic Billing in West Virginia — Frequently Asked Questions
Do chiropractic billing rules differ in West Virginia?
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Mountain Health Trust is delivered through commercial managed care plans, each setting its own filing window and authorization rules.
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