Palladian is URAC accredited in Health Utilization Management, adheres to the National Committee of Quality Assurance (NCQA) standards, and all applicable State regulations.  Palladian is held accountable by these accrediting/regulatory bodies, and by their healthplan clients, to ensure providers and their administrative staff thoroughly understand Palladian's policies, procedures, and expectations, and the available resources to assist them in their daily operational functions.  

POLICIES AND PROCEDURES

• Accessibility of Service Standards (QI11)
• Complaint Policy (5A)
• Complaint Policy (5B)
• Notification of Clinical Utilization Management Decisions (UM2)
  • Letter Content Grid - Written Notification of Clinical Management Decisons (UM6)
• Medical Necessity of Radiological Services (UM18)
• Medical Necessity of Clinical Services (UM19)
• Member Grievance/Appeal Process (UM16)
  • Guidelines for Review of Adverse Benefit Determination (UM16AppendixA)
  • Guidelines for Review of Adverse Benefit Determination - (Family Health Plus / Medicaid) (UM16AppendixF)
• Network Practitioner Office Standards (QI6)
• Policies for Appeal (UM7)
  • NYS Article 49 (UM7AppendixA)
  • Federal Medicare Advantage (UM7AppendixD)
  • NYS Government Programs (UM7AppendixF)
• Standard Medical Record Documentation Review (QI5)
• Timeliness of UM Decisions (UM4)
  • NYS Article 49 (UM4AppendixA)
  • Connecticut (UM4AppendixC)
  • Federal Medicare Health Plans (UM4AppendixD)
  • NCQA (UM4AppendixG)
  • New Jersey (UM4AppendixB)
  • NYS Government Programs (UM4AppendixF)
• Timely Filing of Services (UM17)
• Transition to Care (UM5)
• UM Communication Services (UM3C)
• Notification of Clinical Utilization Management Decisions (UM6)