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Provider Manual

Prior Authorization of Outpatient Physical Therapy, Occupational Therapy and Speech Therapy

Last Updated on November 16, 2018

Security Health Plan is implementing a prior authorization requirement for outpatient therapies, including but not limited to physical therapy, speech therapy and occupational therapy. As of January 1, 2014, if the therapy provider does not obtain prior authorization, treatment after the initial-evaluation will be denied as the provider’s responsibility.

 

Common questions

When do I contact Security Health Plan for Prior Authorization of outpatient therapy?
Prior authorization is not required for the initial therapy evaluation. After the initial evaluation the therapy provider must complete a prior authorization request through Security Health Online or the appropriate forms (Initial Therapy Treatment form or Concurrent Therapy Treatment form) located in the   Provider Document Library  on this website, to request a prior authorization for additional therapy visits.
 
What is the difference between the Initial Therapy Treatment form and Concurrent Therapy Treatment form?
The   Initial Therapy Treatment form   is used following the initial evaluation for approval of the member’s course of care. The   Concurrent Therapy Treatment form   is completed if additional therapy is required beyond the initial course of care. See the     Security Health Plan Provider Manual   for an outline of therapy guidelines.
 
To which members and insurance products does this requirement apply?
This requirement applies to all Security Health Plan product lines, with the exception of Badgercare Plus, for services provided by affiliated providers.
 
Whose responsibility is it to obtain prior authorization for therapy?

The therapy provider is responsible to obtain the prior authorization following the initial evaluation.  How will the therapy provider be notified that prior authorization has been approved?

If a request has been submitted through Security Health Online, the therapy provider can also check on authorization determination through Security Health Online.

Request submitted on the Security Health Plan Provider Portal or by form fax or mail: Security Health Plan will provide an authorization number to the referring therapist via telephone or provider portal. The therapy provider can obtain the prior authorization number from Security Health Plan by telephone at 1-800-548-1224. 

What is Security Health Plan’s timeliness requirement to complete prior authorization for outpatient therapy?

Security Health Plan has 14 calendar days from the date of Security Health Plan receipt of non-urgent prior authorization requests (via telephone or Security Health Online) to make a determination.

Is the prior authorization required only for the initial course of treatment? If so, once authorized, will any other related services and/or procedures need prior authorization?

If the course of treatment changes, for example change in body part, another prior authorization must be initiated.

Is prior authorization required for members who initiated therapy prior to January 1, 2014?

Prior authorization is required for alloutpatient therapiesas of January 1, 2014 dates of service. For members in an active course of therapy that began prior to January 1, 2014, provider will NOT need to complete a prior authorization request.

Are skilled nursing facilities that are providing outpatient therapy required to complete the outpatient therapy prior authorization process?

Yes.

Does the prior authorization requirement for outpatient therapy apply to all ages?

Yes.

If Security Health Plan is the secondary coverage for a member, is a prior authorization for outpatient therapy required?

Yes.



Last updated: 4/1/2018