InterCommunity Health Network Coordinated Care Organization made several retroactive changes to the original 2023 prior authorization requirements for physical, occupational and speech therapy, and cardiac and pulmonary rehabilitation. Effective for services beginning Jan. 1, 2023, prior authorization requirements have been updated to the following:
- Physical, occupational and speech therapy:
- Authorization is not required for an initial therapy evaluation and the first 10 visits.
- Authorization will be required for 11 or more visits, beginning on the 11th visit.
- Authorization requirements apply for the calendar year, per therapy type.
- Cardiac and pulmonary rehabilitation:
- Authorization is not required for the first 30 visits.
- Authorization will be required for 31 or more visits, beginning on the 31st visit.
- Authorization requirements apply for the calendar year, per rehabilitation type.
When submitting prior authorization requests for either physical or occupational therapy, please be mindful of time units for billing. Authorizations for PT/OT must be requested in units, not visits. One (1) visit equals four (4) units.
The retro-authorization time frame for IHN-CCO is 90 days. All retro-authorization requests for these services will be given full consideration during this transition period, including requests with both retrospective and future visits.