Chiropractic Program

Palladian conducts medical necessity review for chiropractic services to assess the patient’s current medical condition, pain, and progression of treatment. The medical necessity review process is user-friendly and designed to gather concise information from you and your patient to determine the appropriate course of care.

When Preauthorization is Required

Members with chiropractic benefits are generally allowed unlimited visits to a network chiropractor, based on medical necessity, preauthorization, and referral requirements, which vary according to the member’s benefit.

The initial visit to a chiropractor does not require preauthorization. Chiropractors must obtain preauthorization from Palladian for the member’s second treatment and each treatment thereafter. 

EmblemHealth Plan, Inc. (formerly GHI) Underwritten Benefit Plans

Members may access chiropractic care without a referral or preauthorization for the first eight visits, depending on the member’s benefit. Chiropractors must obtain preauthorization from Palladian for the ninth visit and each treatment thereafter. 

How to Request Preauthorization

Chiropractors and their patients must complete required forms as indicated below. Chiropractors are responsible for submitting all forms to Palladian for review. 

• Chiropractic Treatment Form - completed by the participating therapist
• Chiropractic Intake Form - completed by the patient
• Chiropractic Outcomes Form - completed by the patient; or the
• Pediatric Outcomes Form - completed by the parent or guardian of patients under the age of 18

Below 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 (3) forms need to be submitted within five (5) business days of the initial evaluation.
  • Chiropractic Treatment Form - completed by the participating therapist
  • Chiropractic Intake Form - completed by the patient
  • Chiropractic Outcomes Form - completed by the patient
• For any additional follow-up care after the initial authorization, the following two (2) forms need to be submitted within five (5) business days of the “Requested Start Date.”
  • Chiropractic Treatment Form - completed by the participating therapist
  • Chiropractic Outcomes Form - completed by the patient

NOTE: Failure to submit required forms for authorization may result in an administrative denial.

Once the forms are complete, chiropractors may submit preauthorization requests in one of two ways:

1. Online: Visit evicore.com/palladian.
2. By fax: Use 716-712-2802 for HIP members or 716-712-2817 for EmblemHealth Plan, Inc. (formerly GHI members).