05/06/2026

TPA Practices Undermine Providers and Patient Safety

By Jeff Trinka, DC AAC Reimbursement Fairness Committee Member

A growing concern in musculoskeletal healthcare is the role of third-party administrators (TPAs) in shaping care through policies that may not align with clinical science. Nowhere is this more evident than in the management of chronic pain. Despite well-established guidelines recognizing chronic pain as a condition requiring ongoing, individualized care, some TPA systems continue to apply acute care medical necessity criteria—expecting rapid resolution, limiting treatment duration, and restricting visit frequency. These frameworks are fundamentally mismatched to the clinical realities of chronic neuromusculoskeletal conditions.

04/28/2026

THE QUIET RESTRICTION ON CHIROPRACTIC CARE – BUNDLING’S EFFECT ON PATIENT OUTCOMES

By: Renee Haberl, DC Reimbursement Committee Member

Most chiropractors go into practice with a clear goal: give the right care, at the right time, for the patient in front of them. But in many third-party administrator (TPA) systems, that goal is being limited by one thing: bundling. Bundling groups services into a single payment. In theory, it can improve efficiency. In practice—especially in chiropractic—it often doesn’t fit how patients actually present. Chiropractic care is not one-size-fits-all. Patients range from simple, short-term cases to complex conditions involving chronic pain, functional loss, and multiple health issues.

04/28/2026

Join Us at the AAC 2026 Convention – June 12–14 at Wild Horse Pass Resort & Casino

04/21/2026

Transparency Without Accountability: AI Reveals the Truth Behind Chiropractic Reimbursement

The Transparency in Coverage Rule, implemented in July 2022, requires health plans to publish machine-readable files (MRFs) containing negotiated reimbursement rates.¹ While initially viewed as a step toward openness, the true value of these datasets is only now being realized through the application of artificial intelligence. Using AI-powered analysis of MRF data across Arizona, a clear and consistent pattern has emerged: Doctors of Chiropractic (DCs) are reimbursed significantly less than other provider types for identical billing codes. This is not an isolated finding. It is consistent across payers, regions, and contract structures.