Reading a chiropractic result

When you check a chiropractic patient's plan, the carrier sends back the same detail your team would read off a payer portal. Valian lays it out for a chiropractic office: visits, what each visit costs the patient, and the caps that matter. This article walks through the patient's page, top to bottom.

On the Verification page, click the patient's row for the quick view, then View the full benefits report to open the patient's own page.

Chiropractic benefits

The first card answers the questions you get asked at the front desk. The carrier and plan are named on its right.

• Chiropractic: Covered, Not covered or Not active, and whether you are in or out of network.
• Per visit: what the patient pays at each visit, for example a copay, or a coinsurance percent after the deductible. Max met means the out-of-pocket max is used up, so no copay or coinsurance is due.
• Visits: visits left, with a bar of how many are used out of the plan's cap and the period it covers (a calendar year, for example). When the carrier says visits are approved by medical necessity, the tile says so in its words. When the carrier sends no visit cap at all, the tile shows — with "usually medical necessity": that is the usual case, not the carrier's answer.
• Deductible: what is left to meet, or Met.
• Out-of-pocket max: what is left before the plan pays 100% of its allowed amount.

Plan summary

Patient pays, by service shows what the patient pays for each kind of chiropractic care, on the network side that was read:

• Exams & evaluation
• Spinal adjustments
• Therapies & rehab
• X-rays & imaging
• Supports & supplies

Each tile reads a copay, a coinsurance percent, Plan pays 100%, Not covered, or Full fee when no visits are left.

Limits · caps, prior authorization, family and plan year shows:

• Dollar cap on chiro: a yearly or per-visit dollar cap, and what is left of it, or None when the carrier says there is no cap.
• Prior authorization: Required or Not required for chiropractic, when the carrier says.
• Family deductible and Family out-of-pocket: the carrier's two numbers.
• Plan year: how many days until visits and the deductible reset.

Plan basics and Cards on file

Plan basics holds the details the check was run against: the carrier, the plan, the member ID, the group number, the policy holder, the plan year and your network. Cards on file, beside it, holds the insurance card and the photo ID. See Cards on file.

Coverage by service

Coverage by service lists your own codes from Settings › Services, grouped the way the plan pays for them, with a price per service. When a fee schedule applies, an Allowed column shows what the payer allows for each code. See Allowed amounts and fee schedules.

Plan usage, in and out of network

Plan usage · in and out of network puts both sides of the plan next to each other: the deductible, the out-of-pocket max, visits, and the cost per visit. Rows that differ by network stand out.

Special clauses & limitations

What the carrier says about this plan beyond the numbers above, as plain carrier facts: visit rules, exclusions, and notes such as another plan paying first. When the carrier says another plan pays first, or calls this plan a supplement, this card offers + Add primary plan. See Cards on file.

EOBs and history

When Valian does your billing, the patient's payment letters (EOBs) show under Special clauses & limitations. At the bottom of the page, Verification history keeps every check, and Open report shows any past answer exactly as the carrier gave it. See Past checks and verification history.

On your patient list

At a chiropractic office, each patient's line shows the Out-of-pocket max left on a bar, then Visits left, then the deductible.

Frequently asked questions

Visits shows "—". Does the plan have unlimited visits? No. It means the carrier sent no visit cap. Most plans then approve visits by medical necessity. Ask the carrier if you need a number.

The plan is Medicare. Connect your office to Medicare first. See Medicare checks.

Can I price a visit from this? Yes. See Pricing a chiropractic visit.