Chapter 24: Chiropractic Program

EmblemHealth partners with Palladian Muscular Skeletal Health (Palladian), a specialty network and utilization management organization, to manage chiropractic services for our Commercial and Medicare members according to their benefit plans. Palladian is responsible for the administration of preauthorization, payment for professional claims, and appeals for denial determinations made on professional claims (excluding members with Medicare plans). In addition, Palladian is responsible for credentialing and re-credentialing of network chiropractic providers.

Palladian is also responsible for preauthorization of chiropractic services administered to eligible members at a hospital outpatient facility. However, claims payment and appeals for denial determinations of these services are handled directly by EmblemHealth. 

See the Directory chapter of this Provider Manual for Customer Service and Claims contacts.

Medicaid members do not have chiropractic benefits. 

Members whose care is managed by Montefiore Medical Group (CMO) or HealthCare Partners (HCP) Cohort I, or who are in an EPO plan, are not managed by Palladian. Practitioners must contact the applicable organization for preauthorization. Check the member’s ID card or eligibility information on emblemhealth.com/providers to determine the entity responsible for managing a member’s care.  

Palladian conducts a medical necessity review process 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 help 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 (according to the member's benefit).

HIP/HIPIC Underwritten Benefit Plans
For members with benefit plans underwritten by EmblemHealth’s companies Health Insurance Plan of Greater New York (HIP) and HIP Insurance Company of New York (HIPIC), the initial visit to a chiropractor does not require preauthorization. Chiropractors must obtain preauthorization from Palladian for the member's second (2nd) treatment and each treatment thereafter.

GHI Underwritten Benefit Plans
Members may access chiropractic care without a referral or preauthorization for the first eight (8) visits, depending on the member's benefit. Chiropractors must obtain preauthorization from Palladian for the ninth (9th) 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.

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 palladianhealth.com.
  2. By fax: Use 716-712-2802 for members with benefit plans underwritten by HIP/HIPIC or 716-712-2817 for members with benefit plans underwritten by GHI.

If your request for medical necessity review is denied, you will receive information from Palladian regarding your appeal rights.

For Commercial members, appeals for denial determinations made by Palladian must be submitted to:

Palladian Muscular Skeletal Health 
Attn: UM Department
2732 Transit Road
West Seneca, NY 14224

For Medicare members, appeals for denial determinations made by Palladian must be submitted to EmblemHealth as described in the Dispute Resolution for Medicare Plans chapter of this Provider Manual.

Palladian is responsible for the credentialing and recredentialing of chiropractors who are part of their network. All others, see the Credentialing chapter of this Provider Manual. 

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