Posted in Insurance, Training, Updates

EmblemHealth (NY) Physical Therapy/Occupational Therapy Program Reminder

This is a reminder for PT/OT providers that see EmblemHealth HIP (Health Insurance Plan of Greater NY), and HIPIC (Insurance Company of NY), and GHI EPO/PPO non-City of New York patients (added to the list)

EmblemHealth partnered with Palladian Muscular Skeletal Health- a specialty network and utilization management company.

Q1.  What is Palladian is responsible for?

A1. Palladian is responsible for the following functions:

a. Administration of Prior Authorizations PT/OT services in outpatient setting  (private physician Office)

b. Administration of Prior Authorizations PT/OT services done in hospital outpatient facility setting, only for eligible members.

c. Payment for PT/OT professional claims

d. Appeals for denied claim determinations – professional claims

e. CREDENTIALING And RE-CREDENTIALING of network PT/OT providers.

Q2. What plan is excluded?

A2. Medicare Plans

Q3. What is EmblemHealth is responsible for?

A3. EmblemHealth is responsible for payment and appeals for denied determinations of PT/OT services that are performed in the hospital outpatient facility setting.

Q4. How to submit PT/OT request?

A4. Please visit  Palladian website: http://www.palladianhealth.com or by phone: 877-774-7693 or by fax: 716-809-8324

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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