The effective date for launching the delegated spine care management program with Palladian Health has been amended to January 14, 2019. Until this new launch date, you will be unable to complete and obtain authorizations via the process outlined at our educational sessions. The Health Plan’s current authorization requirements will remain in effect and the Palladian Health authorization will not be required until the new date of January 14, 2019.
To learn more please click the link below to join us in a webinar on January 11, 2019 from 12:00 – 1:00 PM EST.
We greatly appreciate your patience and understanding during this transition. We want to ensure that all new processes are fully tested prior to deploying the new authorization requirements to our network providers and members.
Please feel free to contact The Health Plan at 1.877.847.7901 or your provider engagement representative with any questions you may have regarding the new implementation date or pre-authorization requirements.
Please see the original announcement with the amended implementation date below:
ATTENTION: All providers treating back pain and musculoskeletal conditions including chiropractors, physical therapists, occupational therapists, surgeons, orthopedists, neurologists, neurosurgeons, pain management specialists and clinics, physiatrists, and anesthesia pain management specialists:
Beginning January 14, 2019, Palladian Health will be performing prior authorization and medical necessity reviews as follows:
- All services related to spine care management, (including injections, spinal surgeries, and spinal stimulation, etc.) require prior authorization and medical necessity review by Palladian Health
- Includes all commercially insured fully-funded plans (including HMO, PPO and POS plans), all Medicaid plans, and all Medicare Advantage plans.
- Does not include participants in self-funded plans
- Diagnostic imaging reviews, MRI, etc., will continue to be completed by The Health Plan
- All PT and OT - all services after initial evaluation require prior authorization and medical necessity review by Palladian Health.
- No referral or prior authorization is required for the initial evaluation (members may self-refer for evaluation).
- Services related to the treatment of autism spectrum disorder will continue to be managed by The Health Plan in the Behavioral Health Unit.
- All chiropractic care – all services after initial evaluation require prior authorization and medical necessity review by Palladian Health.
- No referral or prior authorization is required for the initial evaluation (members may self-refer for evaluation)
- Palladian Health will complete medical necessity review after the initial evaluation.
- All X-rays performed in the chiropractic setting require prior authorization
Medical necessity review and prior authorizations may be completed through The Health Plan online portal located at https://myplan.healthplan.org/Account/Login, via fax at 1.844.681.1205, or telephonically at 1.877.244.8514.