First Coast Service Options' (First Coast’s) Medical Review department is returning a high volume of pre-approval requests for therapy services forms due to inaccurate, incomplete, or invalid information. Requests that are returned will not be processed. Corrections must be completed and a new request submitted.
The following list has been developed to assist you in avoiding this situation. These are some things you should check for before faxing or mailing your form:
- Verify that you are submitting the pre-approval request during your appropriate phase. Pre-approvals may not be submitted earlier than 15 days prior to the beginning of your applicable phase.
- Do not send in documentation without the completed pre-approval request form.
- Do not use your own coversheet when faxing the pre-approval form. The completed pre-approval form will serve as your coversheet.
- Do not split a single request into multiple faxes. All documentation for a single pre-approval request must be submitted together.
- Do not submit duplicate requests. Physical therapy (PT), occupational therapy (OT), or speech language pathology (SLP) must be checked on the pre-approval form to indicate the therapy discipline that the additional days are being requested for. If a patient is receiving multiple disciplines (e.g., OT, PT) that you are requesting additional therapy days for, two separate requests must be submitted.
- Provide the correct provider transaction access number (PTAN) and/or national provider identifier (NPI) of the applicable facility or individual depending on whether this is for a Part A facility/entity or Part B individual/performing provider. If listing a facility/entity, report the legal business name as reported to the Internal Revenue Service (IRS).
- You must include the name and telephone number of the person to contact regarding the pre-approval request. Providers and therapists that are currently on any type of corrective action (e.g., probe, prepayment review, probe, prepayment review, zone program integrity contractor, etc.) process are not exempt from prepayment review and should consider whether the pre-approval process is beneficial for your office.
Regardless of whether you receive a confirmation for approval or denial of additional therapy days, once the services are rendered and a claim is submitted, First Coast will request the medical records for review prior to determining whether payment will be made.