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Provider Manual
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.
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.