Chiropractic Program > Submitting Requests For Medical Review
Medical necessity determinations for future care are based on the completion of three concise clinical intake forms:
These forms are on www.emblemhealth.com and on www.palladianhealth.com. The practitioner is responsible for submitting all forms to Palladian for review. Practitioners may submit the completed forms electronically by logging onto www.palladianhealth.com or they may fax them to Palladian at 1-716-809-8324.
Following are examples of the forms required for different scenarios:
- For every new patient and when there is a change in the primary diagnosis, the following three forms need to be submitted within five business days of the initial evaluation.
- For any additional follow-up care after the initial authorization, the following two forms need to be submitted within five business days of the "Requested Start Date."
All requests for additional care may be submitted to www.palladianhealth.com.
Glossary terms found on this page:
Services that have been approved for payment based on a review of EmblemHealth's policies.
An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.
An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.
Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.