The following form and and Frequently Asked Questions are designed to help ensure that providers are able to collect all appropriate funds from the patient. Please note that in order to be able to collect any funds for non covered services from members administered by ChiroCare, a Financial Disclosure Form must be executed by the patient.

Financial Disclosure Form | PDF

Frequently Asked Questions | PDF

Thank you for your interest in joining the ChiroCare network. To begin the credentialing process, download the Credentialing Packet below, which includes a ChiroCare Application. Fill out the forms and return the completed materials, along with a signed copy of the applicable provider contract and certificate holder form, to ChiroCare. To obtain information on ChiroCare’s provider reimbursement rates, you may call our Provider Services Department at (888) 638-7719.

Credentialing Packet | PDF

ChiroCare Credentialing Guidelines | PDF
ChiroCare Credentialing Submission Checklist | PDF
ChiroCare Network Application | PDF
ChiroCare Satellite Office Application | PDF
Liability Claim Reporting | PDF
W9 Cover Letter | PDF
W9 Form | PDF
Iowa Contract | PDF
Minnesota Contract | PDF
North Dakota Contract | PDF
Nebraska Contract | PDF
South Dakota Contract | PDF
Wisconsin Contract | PDF

ChiroCare requires their network physicians to list ChiroCare on their Certificate of Insurance. For new providers, this requirement must be met when the providers join the ChiroCare network while previously contracted providers are required to do this during re-credentialing. To help you complete this step in the credentialing or re-credentialing process, we have designed the following form for your use.

Request to Add Certificate Holder Form | PDF

Please complete the form and fax it to your malpractice insurance holder.

ChiroCare’s Discount Purchasing Program (DPP) utilizes collective bargaining to offer its network providers discounts on a wide variety of products and services, many of which are already being utilized in your office. To take advantage of this cost-savings opportunity, review the DPP Program Summary and follow the simple steps outlined for those that are of interest to you.

Questions specific to the TRIIUM program may be directed to Mary Gangelhoff at (952) 883-3140. Questions related to the CHIPS program may be directed to Vern at (651) 407-8555. General questions or comments related to DPP may be directed to ChiroCare by calling Tabatha Erck at (651) 389-2007 or submitting an e-mail.

DPP Program Summary | PDF
TRIIUM Enrollment Form | PDF
TRIIUM Vendor List | PDF

Already a TRIIUM member?
Contact Mary Gangelhoff at (952) 883-3140 or mgangelhoff@triium.com to get registered with OfficeMaxSolutions.com, the online shopping and ordering site for TRIIUM’s members.

HealthPartners offers a wide range of insurance products to its members including Medical, Dental, and Workers' Compensation products. ChiroCare and HealthPartners have expanded their agreement to include ChiroCare's delivery of a chiropractic network for HealthPartners Workers' Compensation product effective September 1, 2010. Additional details regarding this product and ChiroCare's role are available through the following resources.

Plan Summary | PDF
FAQ | PDF
Process Flow Overview | PDF
Participating Provider Agreement Addendum | PDF
HealthPartners Workers’ Compensation Provider Manual | PDF
Standard Report of Work Ability Form | PDF
MN Treatment Parameters | LINK

ChiroCare providers who wish to participate in this program must sign the Participating Provider Agreement Addendum and fax or mail the signature page to ChiroCare at:

ChiroCare
Attn: Workers' Compensation Program
1000 County Road E, Suite 230
Shoreview, MN 55126
FAX (651) 389-2009

When submitting the signature page, please make sure the ChiroCare contracted provider's name is legible in the "Name" field.

ChiroCare providers who do not return an executed Addendum signature page will be considered non-par and will not be eligible for workers' compensation referrals.