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Update: PT/OT/ST Service Authorization Processes

Date: 03/28/22

Heritage Health (Medicaid):

Effective April 4, 2022, Nebraska Total Care will update the PT/OT/ST authorization processes for Medicaid services as follows:

For all Nebraska Total Care Medicaid members we will allow the first 12 sessions, per discipline, for a new episode of care to be administratively authorized to expedite services and allow for immediate access to care. There are no changes to our evaluation auth processes, and the evaluation remains a distinct service not included in these 12 initial sessions. Evaluations continue to be able to be billed on the same day as services.

  • Admin Authorization may be called in by the provider, sent in via fax or via the provider portal with the required Medicaid OTR forms until June 30, 2022
  • Effective July 1, 2022, the above processes to support administrative authorization will be retired. At that time our systems will be set up to enable the first 12 sessions, per discipline, for new episodes of care to be done without any administrative authorization
  • For services beyond the first 12 sessions, providers will submit authorization requests with clinical information via the same processes that have historically been in place

If you have questions, please contact Provider Relations.