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