Current News



UnitedHealthcare Eliminates Prior Authorization for Some Outpatient Therapy Services

UnitedHealthcare (UHC) has published a list of CPT codes billed by physical and occupational therapists that will no longer require prior authorization. Continue reading below to find out which CPT codes are being removed from requiring prior authorization for the various UHC plans.

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Highmark Requires Prior Authorization for Speech Therapy

Highmark BCBS has put out a reminder that the CPT codes listed below now require prior authorization for speech therapy since March 15, 2022. The codes are as follows:

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Cohere to Manage Preauthorization for Humana in 2022

Beginning on January 1, 2022, Cohere will manage prior authorizations for outpatient therapy services for most Humana Commercial and Humana Medicare Advantage plans.

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eviCore Has Updated corePath for Physical and Occupational Therapy Authorizations

If you are a Blue Cross Blue Shield (BCBS) provider in the state of Michigan and provide outpatient therapy services, you will want to read this article. eviCore Healthcare has made changes to the corePath therapy authorization model for initial authorization requests for new episodes of treatment. This change applies to: Physical therapy providers in categories B and C Occupational therapists in category B What Has Changed? To access a nice 6-page document that contains frequently asked questions (FAQs) regarding practitioner performance summary and provider category FAQs, click I hope you found this article helpful and informative. Thank you for being

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Humana Resumes Prior Authorization for Outpatient Therapy

On December 18, 2017, Humana announced they would no longer require preauthorization for outpatient physical, speech and occupational therapy services for patients with commercial and Medicare Advantage (MA) coverage. Unfortunately, nothing lasts forever. Effective with dates of service on and after I hope you found this article helpful and informative. Thank you for being a Gold Member!

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UnitedHealthcare Medicare Advantage Plan Changes

Since January 1, 2019, facilities that provide post-acute care inpatient services have been required to request prior authorization and receive a pre-service determination before UnitedHealthcare (UHC) Medicare Advantage Plan members can be admitted to a post-acute care facility or a post-acute care bed in one of the following types of facilities: Acute Inpatient Rehabilitation Skilled Nursing Facilities Long-term Acute Care Hospitals Critical Access Hospitals that provide post-acute services Beginning on October 1, 2019, UHC will

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AIM Specialty Health November 2019 Updates

If you submit claims to Anthem Blue Cross, significant changes are occurring beginning with dates of service on and after November 1, 2019. AIM Specialty Health has announced they will relaunch the AIM Rehabilitative program (i.e. prior authorization) for Anthem’s Commercial Membership on November 1, 2019 for the following states: I hope you found this article helpful. Thank you for being a Gold Member!

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UHC Community Plan Adds 3 States to Prior Authorization

UnitedHealthcare (UHC) Community Plan is adding 3 states (in addition to the 4 previously announced) that will require prior authorization prior to initiating physical, occupational and/or speech therapy services. In addition, UHC Community Plan is adding site of service medical necessity reviews for all speech, occupational and physical therapy services provided in a hospital outpatient setting in 2 of the 3 states. The new impacted states are

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