(1) “Claims review” and/or “independent examinations” are defined as services for third-party entities for the purpose of rendering a decision on chiropractic insurance claims.
(2) Nothing in this section shall prohibit an insurance company or its designees from taking adverse action based upon reviewing a claim if it is determined that the services rendered are not covered under the insurance plan’s schedule of benefits or the services are subject to the insurance plan’s exclusions and/or limitations. No determination adverse to a chiropractic patient or doctor of chiropractic shall be made on any question relating to the necessity or justification of any form of health care services without prior evaluation and concurrence in the adverse determination by a chiropractor licensed to practice in Mississippi and meeting the following criteria:
(a) Present proof of three hundred (300) classroom hours of study in insurance claim review by a course of study recognized by the Mississippi State Chiropractic Examining Board. Such proof is to be filed with the Executive Secretary of the Mississippi State Board of Chiropractic Examiners.
(b) Present proof to the Executive Secretary of the Mississippi State Board of Chiropractic Examiners ten (10) hours of continuing education each fiscal year in the instruction or developments in claims review, which must be approved by the Mississippi State Board of Chiropractic Examiners.
(c) Those chiropractors active in doing claims review five (5) years prior to the enactment of this law will be exempt from the three hundred (300) classroom hours educational requirements. Those chiropractors qualifying under subsection (c) of this section must show proof of one hundred (100) hours of study in claims reviews or related subjects, and meet all other requirements.
(d) The Mississippi State Board of Chiropractic Examiners shall issue a certificate to those chiropractors qualifying under this law, and may charge a fee of Twenty-five Dollars ($25.00) to each individual whom the board certifies.
(e) Any chiropractor not complying with this section will be subject to disciplinary action by the Mississippi State Board of Chiropractic Examiners.
(3) No chiropractor shall engage in chiropractic claims review or independent examinations on or after March 19, 1999, unless he has met all requirements in this section.
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