Change to PT/OT/ST Authorization Process Effective November 1, 2017
Date: 10/27/17
Heritage Health (Medicaid):
Nebraska Total Care will have a new fax number and Outpatient Treatment Request (OTR) form for outpatient and home health physical, occupational, and speech therapy prior authorization requests.
**Updated 4/1/2019: please fax all outpatient and home health PT/OT/ST prior authorization requests to the Authorization Fax Number: 1-844-252-4644
The new PT/OT/ST Outpatient Treatment Request (OTR) form is available on the Nebraska Total Care website within the "For Providers" section, within “Provider Resources”, “Practice Improvement Resource Center (PIRC)."
You may also continue to submit therapy prior authorization requests through the Nebraska Total Care Web Portal.
***When you are submitting an authorization requests for PT/OT/ST, please make sure that you are submitting your requests under the “Requesting Provider” as the provider that is providing the service, which would be the therapist. An exception would be if service is provided in facility, then you can submit under facility NPI. (UB Billers)
The following modifiers are applicable:
- GP – Physical Therapy
- GO – Occupational Therapy
- GN – Speech Therapy
Please make sure that you are putting the appropriate modifiers on the claims that you are submitting to Nebraska Total Care. These are required to process claims. If the authorization is not provided, you will receive a denial for “authorization not matching what is billed on your claim”.
If you have questions regarding this notice, please contact your dedicated Provider Relations Specialist or call Nebraska Total Care at 1-844-385-2192 TTY: 711.