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 ................................................................................................