Therapy – Occupational/Physical/Speech

web_alerts

Welcome to the Medical Authorization page for Occupational, Physical and Speech Therapy. This information is designed to assist the providers with submitting prior authorization requests (PAR) correctly the first time. The goal is to streamline the PAR process while maintaining compliance with OHCA, state and federal policy and rules. Please sign on to WEB ALERTS to receive email notifications when changes are made to this web page.

NOTICE:  Effective 7/1/2017, therapy services will be reviewed and processed by the OHCA. All PARs must be initiated using the SoonerCare Provider Portal, including the upload of supporting clinical documentation. Prior authorizations that were previously approved thru our vendor will remain valid.

Therapy requests may be considered for a requested time span of up to 1 year from the date of the most recent evaluation or 1 year from the prescription/order.


Required Forms for all Therapy

  • HCA-61
  • SC-15 English | Spanish – Parental Consent Form or Provider-generated Parental Consent Form (if utilizing a provider generated form it must include all information contained on the SC-15 form)
  • SC-16 English | Spanish– Change of Provider Form (if applicable)

Guidelines for Speech Services

 

Guidelines for Occupational and Physical Therapy Services

In an effort to expedite prior authorizations for initial post-operative and acute injuries, we allow the use of an SC modifier for Occupational and Physical Therapy requests. Please see Provider Letter 2012-09 for guidance on the appropriate use of this modifier.

 

FAQs 

   


PA Status Explanations

PA Status

PA Explanation

Approved    

Line has met the medical necessity and been approved.
PAs are not a guarantee of payment due to a variety of
reasons such as eligibility, etc.

Denied     

Line is denied by a consultant or physician as not being
medically necessary based on the documentation submitted.

Evaluation

Line is currently waiting to be reviewed by MAU staff

Pending

Line is pending to the next level of review

Pending
Documents     

Line has been pended back to the provider who
submitted the request to obtain additional documentation -
Remarks section in the PA on the Provider Portal will indicate 
to the provider what is needed. Provider will have 10 days
to submit the requested information  

System
Cancelled     
      

Line is cancelled by the system for various reasons such as
Non-Covered Services, No Eligibility, Medicare Primary, No 
Documents submitted for review, Requested Documentation
not received, etc.