FLASH: 2019 Memorial Health System Employee Plan Changes

Chiropractic Services

Effective January 1, 2019, Memorial Health System will bring a chiropractic network to the Memorial Health System employees through an agreement with Empower. Memorial employees will have specific chiropractic care benefits, with limits. Here are some key points:

• A referral to a chiropractor must be in place and must come from the member’s primary care provider (PCP).
• If no referral is in place, the claim will be denied to the member.
• A specific referral form must be used, which is posted in the Forms & Resources section of Your Health Alliance for providers.
• PCP offices can either fax referral forms to 217-902-9777 or email them to our claims support team at *Team-ClaimsSupport@healthalliance.org.
• Claims must be coded with a chiropractic CPT code and a neuromusculoskeletal ICD-10 code.

Non-Emergent High-Cost Procedures and Outpatient Surgeries

Effective January 1, 2019, non-emergent high-cost procedures (HCP) and outpatient surgery (OPS) for Memorial Health System employees are required to be performed at a Memorial Health System facility to qualify for in-network benefits. Here are some key points:

 If an in-network provider who is not a Memorial Health System provider performs these services, the claim will be paid as out-of-network. Please review the CPT code list for HCP.

MHS In-Network Facility Provider List

• Memorial Medical Center
• Passavant Area Hospital
• Taylorville Memorial Hospital
• Abraham Lincoln Memorial Hospital

Please contact the Health Alliance Customer Service Department or your provider relations specialist for more details.

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