PT/OT/ST Service Authorization Tips

Date: 08/03/20

Heritage Health (Medicaid):

Reminders for Physical, Occupational and Speech Therapy authorization requests.

• The OTR form should be filled out and contain the information for the ‘Requesting Provider’ (MD, DO, PA-C, or Nurse Practitioner), as well as the ‘Servicing Provider/ Facility Information’ (therapist performing the service or the facility information
• The ‘Supplemental Information Needed for PT/OT/ST Authorization Requests’ form should be completed
  • The requested frequency, duration, and number of visits on this form should reflect what is supported on the order or plan of care that is signed by the requesting provider (MD, DO, PA-C or APRN)
• The attachments should include:
  • Prescription for therapy: Signed by a MD, DO, PA-C or APRN
  • Nebraska Total Care  is now accepting orders signed by a Physician’s Assistant (PA-C) for all therapy and Durable Medical Equipment requests
  • Current assessment including measureable objective information
  • Current plan of care, signed and dated, specifying frequency, duration and type of treatment
  • Continuation of care requests must include specific and measureable baseline and current status for all goals

If you have questions, please contact Provider Relations.