Emblem Health/GHI Authorization Update

on . Posted in Commercial Insurances

Changes to Medicare PPO Prior Approval Rules for PT/OT/ST

EmblemHealth will implement new prior approval rules for physical therapy, occupational therapy and speech therapy for our Medicare PPO members, effective August 1, 2013. Under the new policy, EmblemHealth will require prior approval for these services after the sixth visit. At present, prior approval is required after the twentieth visit.

How to Obtain Prior Approval

To obtain a prior approval, sign on to www.emblemhealth.com. Fax the Prior Authorization request to 1-866-725-6603, or mail your request to:

EmblemHealth Coordinated Care Unit 441 9th Avenue, 7th Floor New York, NY 10001

Urgent or expedited prior approval requests required after business hours (Monday - Friday from 8:30 am - 5 pm) should be made by calling 1-866-557-7300. For questions regarding the status of a request submitted or the authorization process, call Customer Service at 1-212-615-4662 or toll free at 1-800-223-9870.

 

Aetna's Coverage Policy for Acupuncture CPB 0135

on . Posted in Commercial Insurances

AETNA’S COVERAGE POLICY FOR ACUPUNTURE CPB 0135

Aetna considers needle acupuncture (manual or electroacupuncture) medically necessary for any of the following indications:

  • Chronic low back pain. (Maintenance treatment, where      the patient’s symptoms are neither regressing or improving, is considered      not medically necessary.  If no clinical benefit is appreciated      after 4 weeks, then the treatment plan should be re-evaluated); or 
  • Migraine headache; or
  • Nausea of pregnancy; or
  • Pain from osteoarthritis of the knee or hip (adjunctive      therapy; if no clinical benefit is appreciated after 4 weeks, then      the treatment plan should be reevaluated); or 
  • Post-operative and chemotherapy-induced nausea and      vomiting; or
  • Post-operative dental pain; or
  • Temporomandibular disorders (TMD)

Remember to verify coverage for each patient and confirm if their plan has benefits for acupuncture services.

Company Info

Welcome to Precision Billing & Consulting Services, LLC, a full service billing and consulting agency serving the entire nation.

Precision Billing & Consulting Services, LLC, allows you to save money while eliminating the headaches and worries of staying compliant with insurance regulations.

Upcoming Seminars

Thursday, September 17, 2015

Focusing on the following specialties: Acupuncture, Chiropractic, Occupational Therapy, Orthopedic, Physical Therapy, Podiatry, Sports Medicine

Tuesday, September 22, 2015

Focusing on the following specialties: Internal Medicine, Cardiology, Genitourinary

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