Thank you to the doctors who brought recent Blue Cross and Blue Shield of Kansas City claim denials to our attention. Based on those reports, KCA reviewed the claims information available through Infinedi Analytics for Kansas chiropractic providers.
Our preliminary analysis found a notable pattern beginning in January 2026. Approximately 30% of Blue KC service lines were identified as unpaid in November and December 2025. From January through May 2026, that figure ranged from approximately 46% to 58%.
This increase warrants further investigation. However, the available information does not yet allow us to conclude that all these unpaid service lines were improperly denied—or that they involved chiropractic manipulative treatment codes 98940–98942.
Some of the January increase may be associated with annual deductibles resetting. Infinedi may also classify patient responsibility, pending claims, unmatched remittances, and other adjustments as “unpaid.” Nevertheless, the unpaid rate remained elevated through May, suggesting that deductible resets may not explain the entire pattern.
The available adjustment data includes reasons involving noncovered services, benefit maximums, bundling, diagnosis coverage, duplicate claims, and modifier inconsistencies. Infinedi also identified recurring CMT-related claim errors. Unfortunately, the dashboard aggregates all procedure codes, so we cannot determine how many of these adjustments were applied specifically to 98940–98942.
KCA’s Next Steps
KCA is requesting de-identified, service-line-level data from Infinedi for CMT claims submitted to Blue KC. We are seeking information that will help us:
- Separate actual denials from deductibles, coinsurance, copayments, and pending claims;
- Identify the adjustment and remark codes applied to 98940–98942;
- Determine whether denial rates increased beginning in January;
- Identify whether initially denied claims were corrected, appealed, or later paid; and
- Compare the current period with the same months from the previous year.
We are grateful to Brad Cost and Infinedi for making this analytics resource available to state chiropractic associations. Access to this information gives associations an important starting point for identifying emerging payment problems.
How Members Can Help
Please continue sending KCA examples of concerning Blue KC denials. Helpful information includes:
- CPT code;
- Date of service;
- Modifiers and diagnosis codes;
- Claim Adjustment Reason Codes;
- Remittance Advice Remark Codes;
- Date the original claim was submitted;
- Whether the claim was corrected, appealed, or ultimately paid; and
- The final disposition of the claim.
Please remove all patient-identifying information before sending claim materials.
Remember the Kansas Prompt Pay Requirements
Providers should document when clean claims were submitted, acknowledged, denied, and paid. Under the Kansas Health Care Prompt Payment Act, an insurer generally must pay a clean claim or provide notice explaining a delay or denial within 30 days. If additional information is requested, specific deadlines also apply after that information is received.
When the Act applies and its requirements are not met, interest may accrue at 1% per month on the unpaid claim amount. Therefore, claims that were improperly or untimely denied and later paid may also be eligible for interest.
KCA will provide members with another update after we receive and analyze the requested CPT-specific information.
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