Physical, Speech and Occupational Therapy
eviCore healthcare has been contracted by Security Health Plan to provide prior authorization (PA) review of certain therapy services for dates of service (DOS) May 1, 2019 and forward.
These authorizations will be for members enrolled in Security Health Plan Commercial, BadgerCare, and Medicare Advantage plans and the Security Administrative Services (SAS) plan for the Marshfield Clinic Health System Employer group. For all other SAS groups please review each member ID card to find the utilization management vendor (e.g. Hines) and prior authorization requirements.
It is the rendering provider’s responsibility to ensure prior authorization requirements are met before a member’s scheduled appointment. If PA requirements are not met, claims could be denied.
Marshfield Clinic rendering providers should contact Security Health Plan to obtain prior authorization for members.
Non-Marshfield Clinic rendering providers should contact eviCore to obtain prior authorization for members, per the guidelines outlined above and in the provider training materials.
Therapy and interventional pain management services performed in conjunction with an inpatient stay, 23-hour observation or emergency room visit are not subject to prior authorization requirements.
Authorization is required for:
- Occupation Therapy
- Physical Therapy
- Speech Therapy
To request a prior authorization:
- Login to www.evicore.com/pages/ProviderLogin.aspx
- Call eviCore at 1-888-444-6185
- Fax an eviCore healthcare request form (available at www.evicore.com) to 1-888-785-2485
For urgent requests:
If services are required in less than 48 hours due to the severity of the clinical presentation, please call eviCore’s toll-free number or you can initiate a case via the eviCore web portal for expedited prior authorization review. Be sure to tell the eviCore representative that the prior authorization request is for an urgent clinical presentation. If initiating the urgent request via the web you will have to upload clinical documentation with the case initiation.To request an authorization, submit your request online, by phone or fax:
View code list for the following prior authorizations:
- Physical therapy and occupational therapy services
- Authorization request overview for physical, occupational and speech therapy services
- Therapy program quick reference guide
- eviCore therapy program FAQ
- SMART Goal Overview
- Speech therapy
- Clinic Speech therapy QRG
- Speech therapy Adult Checklist
- Speech therapy Pediatric Checklist
Physical and Occupational therapy:
- Clinic Physical and Occupational QRC
- Administrative Physical and Occupational QRC
- Pediatric Initial and Occupational Therapy Prior Authorization Clinical Checklist
- SMART Goal - Physical and Occupational Therapy
eviCore healthcare’s Clinical Guidelines and request forms are available at: www.evicore.com or click here to access guidelines specific to Security Health Plan. Please call the Client Provider Operations department at 1-800-646-0418, option 4, if you have any questions or need more information.