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  • Physical Therapy Precertification Review Form - BCBSAL
    In addition to this form, please fax medical records for the initial evaluation; the last five treatment notes and exercise flowsheets, therapy order, plans and goals; and current reassessment, if applicable
  • Forms and Documents | Providers - BCBSM
    Looking for the right form or document to help care for your patients? Find what you need to get your work done quickly Find out more about registering for Availity ® Essentials Michigan providers should attach the completed form to the request in the e-referral system
  • Resources - provider. bcbsal. org
    Once benefits are verified, use the forms below to obtain precertification for services These forms must be filled out completely and be accompanied by all required information, as noted on the forms This includes: Copy of initial evaluation; Current plan of care; Last five treatment notes exercise flow sheets
  • Outpatient Rehabilitation Therapy - Blue Cross Blue Shield of Massachusetts
    The 60-visit maximum combines benefits for physical therapy (PT) and occupational therapy (OT) services Speech therapy (ST) benefits are generally not included in the combined PT OT short-term rehabilitation benefit
  • Provider Documents and Forms | BCBS of Tennessee
    Start by choosing your patient's network listed below Here are some of the common documents and forms you may need in order to treat our members and do business with us
  • Authorization requirements by product - Blue Cross Blue Shield of . . .
    You can learn authorization requirements for patients when you verify their eligibility using an eTool like Authorization Manager If you are an in-state 1 provider and need to submit an authorization request for: • Blue Cross Blue Shield of Massachusetts members, you must 2 use Authorization Manager Log in to bluecrossma com provider
  • Forms - Highmark
    Find all your necessary Highmark forms here Manage your account, update your profile, or notify Highmark of a change in status Access precertification worksheets, requests for surgical services, and more View a variety of forms for prescription drug medication requests
  • Outpatient Therapy Services Prior Authorization Request Form
    Use this form for all physical, occupational, speech, and feeding therapies, pulmonary and cardiac rehabilitation, and chiropractic care Complete and fax all requested information below including any supporting documentation as applicable to Highmark Health Options at 1-855-451-6664 Authorization is based on medical necessity
  • BCN Physical, Occupational and Speech Therapy Management and Physical . . .
    How to submit prior authorization requests To learn how to submit requests, see our Getting Started page Submit requests before providing services Utilization management criteria To view utilization management criteria for commercial members, go to the Services That Need Prior Authorization page on bcbsm com
  • Prior Authorization | Blue Cross Blue Shield of Massachusetts
    For some services listed in our medical policies, we require prior authorization When prior authorization is required, you can contact us to make this request Outpatient Prior Authorization CPT Code List (072)





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