INSURANCE ALERT – Premera & Triwest CCN – VA Applying MPPR

by | Oct 30, 2026 | Insurance - provider, News

PREMERA BLUE CROSS BLUE SHIELD OF ALASKA
Effective for dates of service on or after December 4, 2026

Premera has updated its payment policy for Physical Medicine and Rehabilitation Services (CP.PP.099.v4.0, published August 25, 2026). The update adds an “Always Therapy Multiple Procedure Reduction.” The policy applies to Premera Blue Cross Blue Shield of Alaska plans, among others.

How it works:

  • What it applies to: “Always therapy” services, meaning codes CMS flags as therapy regardless of who performs them. These include common codes such as 97110, 97112, 97124, 97140, and 97530.
  • The first procedure: When two or more of these procedures are billed for the same patient on the same date of service, the highest-allowed procedure is paid at 100% of the fee schedule, or the billed charge if that’s lower.
  • Each additional procedure: Every other procedure is reduced by 50% on the practice expense portion of its allowance. That portion covers overhead and administrative costs.
Some employer group plans may have benefits that override the policy.
The Alaska Chiropractic Society is actively fighting this change. We recently met with the Director of the Alaska Division of Insurance, who is following the situation closely. We formally raised several concerns:
  • Long phone wait times, non-English speaking representatives
  • Delays in responding to provider appeals and emails
  • No in-state contacts for issues providers are having
  • Whether contract terms are being honored
  • Years with no network compensation increases
  • Addition of multiple payment policies reducing payment for care or bundling services
The Division of Insurance is actively working with ALL the healthcare associations as one united group to find some resolution to the painful issues our providers have been dealing with.  We appreciate our members who believe that “together we are stronger” along with gratitude to the Alaska State Medical Association, Alaska Physical Therapy Association, and the Alaska Occupational Therapy Association for combining efforts to solve our mutual issues.
Premera resources:
VA Community Care (TriWest)

TriWest administers VA Community Care in Regions 4 and 5. Region 5 is Alaska. Providers in other states report that TriWest is sending overpayment letters that recalculate claims as far back as 2023 and demand repayment. The letters mainly involve massage codes (97124 and often 97140). Chiropractic offices that bill these codes could also be affected. The likely cause is MPPR being applied after the claims were paid. TriWest states that it follows Medicare billing guidelines, fee schedules, and payment methodology when applicable.

No Alaska provider has contacted the Alaska Chiropractic Society about these letters so far, but we want every office prepared.

If you receive a letter:

  • Note the response deadline right away. Deadlines can be short, so check the one printed on your letter.
  • Check the reason the letter cites, such as pricing/MPPR, authorization, duplicate payment, or documentation.
  • Pull the referrals, notes, and remittances for each listed claim.
  • Dispute in writing before the deadline, following the instructions on your letter. TriWest’s online Provider Claims Reconsideration Form is one option. Submit a separate request for each disputed item, and ask TriWest to show its calculation and the policy it applied.
  • Let us know at insurance@akchiro.org.

Don’t ignore a letter. Unpaid overpayment balances are offset against your current and future claims by PGBA, TriWest’s claims processor. Leaving the network does not erase a past overpayment.

TriWest resources:

Separately, the VA has moved to a new internal system, which is why some offices are seeing payment delays on billings and authorizations.

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