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Chiropractic Resources

  • pdf icon Chiropractic Reference Manual This manual has information regarding medical necessity requirements, utilization management, billing, and documentation requirements.
  • pdf icon Chiropractic: Treatment Request Form This form should be used to request prior authorization for chiropractic services for members with contractual visit limitations.
  • pdf icon ICSI: Clinical Practice Guidelines for Low Back Pain The clinical practice guidelines focus is on the acute (pain for up to 7 weeks) and sub-acute (pain for between 7 and 12 weeks) phases of low back pain. It includes the ongoing management of low back pain, including indications for spine specialist referral within the first 12 weeks of onset.
  • pdf icon Keele STarT Back Tool The Keele STarT Back Screening Tool (SBST) is a simple prognostic questionnaire that helps clinicians identify modifiable risk factors (biomedical, psychological and social) for back pain disability. The resulting score stratifies patients into low, medium or high risk categories.
  • pdf icon Neck Disability Index Questionnaire The Neck Disability Index Questionnaire (NDI) is a 10-item questionnaire that measures a patient’s self-reported neck pain related disability.
  • pdf icon Oswestry Low Back Questionnaire The Oswestry Disability Index is currently considered by many as the gold standard for measuring degree of disability and estimating quality of life in a person with low back pain.
  • pdf icon Roland-Morris Disability Questionnaire The Roland-Morris Disability Questionnaire is a self-administered disability measure in which greater levels of disability are reflected by higher number of a 24-point scale.
  • pdf icon Support Services Referral Form To refer a patient who is a BlueCross BlueShield member to our disease management, case management or health coaching service, complete and fax this form to the number enclosed.