As a reminder, after the initial patient evaluation visit, Harvard Pilgrim requires notification by the servicing provider for outpatient rehabilitative therapy services including physical therapy (PT), occupational therapy (OT), and speech/language therapy (ST).
Beginning on May 23, 2014, requests for PT, OT, or SP services that contain more than 15 visits will be reviewed for medical appropriateness using McKesson’s InterQual Criteria. The medical review will not be applicable to members under age 3 or members of the Choice Plus and Options PPO plans.
The notification process remains the same; providers should continue to supply notification through HPHConnect or by faxing a completed Rehabilitative Therapies Service Request form to Harvard Pilgrim’s referral/authorization team at 800-232-0816. For more information on notification requirements for functional therapy services, please refer to the Outpatient Rehabilitative Therapies Authorization policy in the Provider Manual.