Harvard Pilgrim recently updated our Outpatient Rehabilitative Therapies Notification and Authorization Policy for greater clarity. As a reminder, Harvard Pilgrim covers the initial outpatient Physical, Occupational, or Speech/Language Therapy evaluation. After the initial evaluation, the treating therapist is responsible for notifying Harvard Pilgrim of the need for further treatment. In specific situations, additional clinical documentation may be required for approval of treatment.
Outpatient treatment is covered for eligible members within applicable benefit limits if there is reasonable medical expectation of significant functional improvement and service-specific criteria are met.
To provide notification, please submit your request in HPHConnect (Harvard Pilgrim’s web-based transaction service). Through HPHConnect, you will receive a quick response on your request and can view the number of visits for which the member is approved, as well as the member’s benefit information for outpatient rehabilitative services (benefit limit and a count of how many visits the member has used). Alternatively, you may fax a completed Outpatient Rehabilitative Therapy Services Notification and Authorization Form to 800-232-0816.
If you would like to request additional visits, you’ll need to complete this form. To request additional services, enter the request through HPHConnect and fax the completed Outpatient Rehabilitative Therapy Services Notification and Authorization Form to 800-232-0816.
For complete information, please refer to the Outpatient Rehabilitative Therapies Notification and Authorization Policy posted in Harvard Pilgrim’s online Provider Manual.