Observation Stays No Longer Subject to Concurrent Review

Authorization Process Updates—Therapy Services

Friday, October 28, 2016

FirstCare Health Plans is dedicated to ensuring our members get the care and services they need while exercising good stewardship in administering benefits properly. 
 
As a reminder, FirstCare Health Plans’ authorization process for Physical Therapy, Occupational Therapy and Speech Therapy requires submission of clinical information to demonstrate medical necessity.  When requesting therapy services, please include an evaluation or re-evaluation.  Additional clinical information may be requested.
 
For Medicaid Members:
Please reference your Texas Medicaid Provider Procedures Manual Vol. 2 - Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook for an overview of all standard requirements.  This handbook can be found at www.TMHP.com. Please review sections describing:

  • Frequency and Duration Criteria  (4.5)
  • Standardized Testing and Developmental Delay Criteria (5.3)
  • Requests for Recertification - every 180 days (5.2.5)
  • Patient and Caregiver Participation in Therapy and Home Program (5.2.5.1)
  • Functional Goals (4)
  • Criteria for Discontinuation of Therapy (4.6)
For all Members: 
Criteria for the above therapies is available upon request.
 
 
If you have questions, please email Provider_Relations@FirstCare.com, or contact your provider relations representative at the number below:
  • Abilene area:               1.325.670.3525
  • Amarillo area:              1.800.239.5650
  • Lubbock area:             1.806.784.4380
  • All other areas:            1.800.431.7737

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