Audience: Physical, Occupational and Speech Therapists
Please remember when requesting additional visits for an existing authorization in CareAdvance Provider, you must complete the following steps:
- Locate and open the authorization entry. Be sure you have the correct provider in focus in the top right corner using the drop-down arrow.
- Locate the “Service” section and click “Edit” and then “Add Service Copy Providers.”
- Complete the required fields and click “Submit.”
- Locate the “Case Communication” section and click “Create New.” Attach any pertinent records and type a message, including your name and contact information.
All requests for additional visits need to be made under the existing authorization, including whether the patient had surgery, or has a new diagnosis or body part to be treated.
Use CPT 97164 for all physical therapy, CPT 97168 for all occupational therapy, and CPT 92507 for all speech therapy authorization requests.
If you have an authorization that was entered originally using our Clear CoverageTM tool, it remains valid. However, if you need to request additional visits, you must create a new authorization request in CareAdvance Provider.
The referring provider should be listed as the individual who referred the patient to therapy (physician, nurse practitioner, physician assistant, physical/occupational therapist, or speech-language pathologist). The servicing provider should be listed as the individual who is providing the therapy service (physical/occupational therapist or speech-language pathologist).
The system only allows for one diagnosis code to be entered. If multiple diagnoses are added to each service line, it appears as if the provider is asking for 10 visits for each diagnosis. Avoid this inaccuracy by adding a note to the “Case communication” to indicate additional diagnosis codes.
All service lines should have the same dates of service. For example, if you enter the original date of service as 7/1/20-12/31/20, the subsequent requests also should be entered with a date of service 7/1/20-12/31/20.
Refer to our CareAdvance Provider Navigation Guide located on our website under Resources, Staff Training, Presentations & Guidebooks for additional assistance.
If you have questions, please contact your Provider Relations representative.
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