The following are some frequently asked questions (FAQs)
relating to outpatient rehab practices.
Credentialing
Q. How do we add new therapists to our office?
A. We do not credential individual therapists, only the facility.
Q. Are we able to add additional practice sites to our GHP contract?
A. Submit your request, in writing, to your provider relations representative. We will review your request and decide if there is a network need. Once a decision is made it will be communicated to your practice.
Q. Does GHP credential Physical Therapy Assistants?
A. No, we only credential the facility.
Patient Eligibility
Q. How can my office check member eligibility?
A. You can access member information on our website thehealthplan.com by using your SuperUser name and password. If you don't have a username and password, please contact your provider representative to assist you.
Benefits
Q. What is the outpatient rehab limit, how many days are covered?
A. Outpatient rehab benefits vary by plan. This information can be found on our website thehealthplan.com under Service Center or by calling our customer service department at 800-447-4000.
Precertification
Q. Is precertification required?
A. Yes.
Q. Who is responsible for precertification of outpatient rehab services?
A. The outpatient rehab provider.
Q. What are the steps to obtain precertification?
A. Precertification information can be found in the Provider Guide and on our website. Below are the instructions.
Initial Request to Precert Outpatient Rehab Services
- Complete the Outpatient Rehab Network Pre-Certification form (Form A), Section 1, attach copy of the initial evaluation, and fax it to the rehab network at 570-271-5302
- OR, complete Sections 1 & 2 and fax it to the rehab network at 570-271-5302
- The rehab provider has 1 week (7 days) from the date of the initial evaluation to submit the precertification request.
NOTE: During the initial 7-day time period, the rehab provider may complete 1 initial evaluation and 1 follow up visit prior to submitting the precertification request.
If Form A is received later than the 7 day time period OR the provider does more than 2 visits in that time frame without obtaining the authorization, then only 2 visits will be considered for authorization.
- Once approved
- Treatment may begin on the same day as the initial evaluation. The initial evaluation is included in the total number of visits authorized by the rehab network.
- The provider will receive a fax from the rehab network will which will include the member name, member identification number, authorization number, discipline being authorized, total number of visits authorized, and authorization end date.
If you do not receive a fax authorization within 24 hours of submitting a precertification request, please call the rehab network at 1-800-270-9981.
Requesting additional visits
- Complete the Outpatient Rehab Therapy Services Concurrent Review Form (Form B) when requesting additional visits.
- In Section 1, indicate the member's information. Then complete Section 3 documenting the number of visits completed.
- OR, submit progress notes indicating the progress and the need for continued treatment. The progress notes must clearly indicate the patient's name and identification number.
NOTE: If or when our rehab network staff needs additional information such as progress notes or needs to speak with the therapist, the providers have two (2) working days to respond. Failure to do so could result in denial of services provided without authorization.
Precertification
Q. Does GHP precert multiple disciplines for your members?
A. Yes. Our Outpatient Rehab Network, based on the member's benefit and medical criteria, will precert all three (3) disciplines. Your office will receive one (1) authorization number to include all three (3) disciplines by the corresponding modifier (GO, GN, GP).
More information regarding outpatient rehabilitation therapy can be found in our Provider Guide or on our website. If you have additional questions, please feel free to contact your provider relations representative.
