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Physical Therapy, Occupational Therapy, and Speech and Language Pathology Providers

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Physical Therapy, Occupational Therapy, and Speech and Language Pathology Providers PhysicalPhysical Therapy,Therapy, OccupationalOccupational Therapy,Therapy, andand SpeechSpeech andand LanguageLanguage PathologyPathology ServicesServices ARCHIVAL USE ONLY Refer to the Online Handbook for current policy CContacting Wisconsin Medicaid Web Site dhfs.wisconsin.gov/ The Web site contains information for providers and recipients about the Available 24 hours a day, seven days a week following: • Program requirements. • Maximum allowable fee schedules. • Publications. • Professional relations representatives. • Forms. • Certification packets. Automated Voice Response System (800) 947-3544 (608) 221-4247 The Automated Voice Response system provides computerized voice Available 24 hours a day, seven days a week responses about the following: • Recipient eligibility. • Claim status. • Prior authorization (PA) status. • Checkwrite information. Provider Services (800) 947-9627 (608) 221-9883 Correspondents assist providers with questions about the following: Available: • Clarification of program ARCHIVAL• Resolving claim denials. USE ONLY8:30 a.m. - 4:30 p.m. (M, W-F) requirements. • Provider certification. 9:30 a.m. - 4:30 p.m. (T) • Recipient eligibility. Refer to the Online HandbookAvailable for pharmacy services: 8:30 a.m. - 6:00 p.m. (M, W-F) for current policy9:30 a.m. - 6:00 p.m. (T) Division of Health Care Financing (608) 221-9036 Electronic Data Interchange Helpdesk e-mail: [email protected] Correspondents assist providers with technical questions about the following: Available 8:30 a.m. - 4:30 p.m. (M-F) • Electronic transactions. • Provider Electronic Solutions • Companion documents. software. Web Prior Authorization Technical Helpdesk (608) 221-9730 Correspondents assist providers with Web PA-related technical questions Available 8:30 a.m. - 4:30 p.m. (M-F) about the following: • User registration. • Submission process. • Passwords. Recipient Services (800) 362-3002 (608) 221-5720 Correspondents assist recipients, or persons calling on behalf of recipients, Available 7:30 a.m. - 5:00 p.m. (M-F) with questions about the following: • Recipient eligibility. • Finding Medicaid-certified providers. • General Medicaid information. • Resolving recipient concerns. TTable of Contents Preface ........................................................................................................................................ 5 Certification and Ongoing Responsibilities ......................................................................................... 7 Other Facilities ......................................................................................................................... 7 Responsibilities ......................................................................................................................... 8 Supervision Requirements ........................................................................................................9 Declaration of Supervision ................................................................................................... 9 Supervision Waiver ............................................................................................................. 9 Durable Medical Equipment and Disposable Medical Supplies ....................................................... 9 Provider Communication .............................................................................................................. 11 Coordination with School-Based Services Providers ................................................................... 11 Coordination with County Birth to 3 Programs .......................................................................... 11 Therapy Services for Children Brochure................................................................................... 11 Guide to Obtaining Augmentative Communication Devices and Accessories ............................... 12 Directory of Used Medical Equipment ...................................................................................... 12 Documentation Requirements ......................................................................................................13 Prescriptions ..................................................................................................................ARCHIVAL USE ONLY ........ 13 Evaluations ............................................................................................................................ 13 Plan of CareRefer ................................................................................................................... to the Online Handbook ....... 13 Daily Entries .......................................................................................................................... 14 Services and Requirements......................................................................................................for current policy .... 15 Initial Spell of Illness ............................................................................................................... 15 Daily Limitations ..................................................................................................................... 15 Duplicate Services.................................................................................................................. 16 Evaluations ............................................................................................................................ 16 Group Therapy ..................................................................................................................... 16 Natural Environments ............................................................................................................16 Durable Medical Equipment and Disposable Medical Supplies ..................................................... 17 HealthCheck “Other Services”................................................................................................. 17 Services Not Separately Reimbursable..................................................................................... 17 Reimbursement Not Available ................................................................................................. 17 Codes ........................................................................................................................................ 19 Procedure Codes ................................................................................................................... 19 Unit of Service .................................................................................................................19 Modifiers ............................................................................................................................... 19 Place of Service Codes ........................................................................................................... 19 Diagnosis Codes .................................................................................................................... 19 Prior Authorization ....................................................................................................................... 21 Prior Authorization Forms and Attachments ............................................................................. 21 PHC 1384 Medical Necessity .................................................................................................................. 21 Relationship of Medical Necessity to Clinical Practice Principles .............................................. 22 Flexibility of Approved Services ............................................................................................... 23 Plan of Care Must Reflect Flexibility of Approved Services ................................................... 23 Duration of Approved Services .......................................................................................... 23 Coordinating Multiple Prior Authorization Requests ............................................................... 23 Requesting Extension of Therapy, Maintenance Therapy, and Services That Always Require Prior Authorization ......................................................................................................................... 25 Approval Criteria .................................................................................................................... 25 Extension of Therapy ............................................................................................................26 Maintenance Therapy ............................................................................................................ 26 Direct Maintenance .......................................................................................................... 26 Monitoring Maintenance .................................................................................................... 27 Discontinuing Maintenance ................................................................................................ 27 Services That Always Require Prior Authorization...................................................................... 28 Cotreatment .................................................................................................................... 28 Dual Treatment ............................................................................................................... 29 Unlisted Procedure Codes ................................................................................................
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