Highmark To Require Prior Authorization for PT & OT Services

August 12, 2012
Rick Gawenda

Highmark Inc., who serves 4.9 million members in Delaware, Pennsylvania, and West Virginia, announced on June 19, 2012 they will begin requiring prior authorization for physical therapy, occupational therapy, and manipulation services beginning September 1, 2012. In the press release, Highmark stated this program applies to Highmark members in insured groups in Pennsylvania and West Virginia. It also applies to Highmark individual members and Medicare Advantage members in those states. Groups that are self-insured may also participate. Members will not need to take any special steps as a result of this program. Providers will work directly with the vendor (Healthways) to obtain authorizations.

Dr. Virginia Calega, Highmark’s Vice President of Medical Management and policy stated “This prior authorization requirement only takes effect after the first eight visits,” said Dr. Calega. “If additional visits are medically necessary, we simply want to ensure there is a proper and appropriate trea

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.


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