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.