GHP Family Provider Manual - Geisinger Health Plan

Please note: Questions regarding an authorization may be directed to the Medical Management Department.Participating Providers must contact the Medical Management Department via phone if they have not received aresponse within two (2) Business Days, in order to confirm that the precertification form was received. An interactivevoice recording (IVR) is in place to accept these calls.• Form 6: Request to Modify Previously Authorized Outpatient DME. In the event a DME ParticipatingProvider requests a modification of an existing Medical Management Department determination, a completedChange Form is required and should be submitted to the Medical Management Department by facsimile. AChange Form may be completed for the following purposes which include, but are not limited to:o Return of DME to the DME Participating Provider (i.e., physician order discontinued, Memberexpired, Member elected hospice benefit, Member voluntary discontinuation; DME ParticipatingProvider should not state, “no longer using”).o Actual date of service changed from the initial anticipated delivery date.o Change to an initial DME request.o HCPCS coding change.o Member identification correction.• Form 7: Extension of an Existing Authorized Outpatient DME: DME Participating Providers are required torequest an extension of an existing authorization decision, as applicable, prior to the expiration date indicatedon the returned original authorized precertification form. This extension request is initiated by the DMEParticipating Provider via the DME Recertification Form. The DME Recertification Form should be completedin its entirety and submitted via facsimile no sooner than two (2) weeks before the end of an authorizationperiod, but no later than one (1) Business Day prior to the expiration date.Outpatient Physical, Occupational and Speech Therapy ServicesPrecertification and Concurrent Review for outpatient rehabilitative services are the sole responsibility of the renderingOutpatient Therapy Participating Provider.Please note:• An Outpatient Referral Form is not required when ordering outpatient rehabilitative therapy services, however,the completion and submission of GHP Family designated form(s) by the outpatient rehabilitative therapyParticipating Provider are required as outlined in this Manual.• Precertification and Concurrent Review are also required when GHP Family is not the Member’s primaryinsurance coverage or when workers’ comp or auto insurance may be primary.• Co-payments are the financial responsibility of the Member, when applicable.A Participating Provider should issue a signed written order to an outpatient rehabilitative therapy ParticipatingProvider when a Member requires outpatient physical, occupational and/or speech therapy services. Outpatientrehabilitative therapy Participating Providers can be located online at www.ghpfamily.com. Outpatient rehabilitativetherapy Participating Providers are required to initiate the request for services within seven (7) calendar days of theinitial rehabilitative evaluation by submitting the Outpatient Rehabilitative Therapy Precertification Form A (availableonline at www.ghpfamily.com) and the prescribing physician’s order via fax submission. If Form A does not haveSection 1 completed in its entirety, it will be considered incomplete.Participating Providers with questions related to outpatient rehabilitative therapy authorization may contact the MedicalManagement Department at the following telephone numbers:GHP Family Medical Management DepartmentMonday through Friday, 8:00 a.m. to 4:30 p.m.42