PT, OT, and ST Services Will Be Managed by Nebraska Total Care and Will Require Prior Authorization Beginning April 1, 2019
Date: 02/15/19
Heritage Health (Medicaid):
Effective April 1, 2019 physical, occupational, and speech therapy services will no longer be managed by National Imaging Associates, Inc. (NIA) and will transition back to management by Nebraska Total Care. PT/OT/ST services provided after this dated will require prior authorization, for all members when provided by a participating provider.
Nebraska Total Care will no longer utilize a post-service, pre-payment review process to manage these services and will return to a prior authorization structure, as they were managed by Nebraska Total Care prior to NIA involvement. To support members who are in a current course of active treatment, Nebraska Total Care will begin accepting authorization requests on March 18th, 2019 for dates of service April 1st, 2019 forward.
Claims for authorized services will continue to be submitted to Nebraska Total Care Health Plan for adjudication. All therapy claims must still contain the appropriate modifier when submitted to the health plan in order to ensure appropriate adjudication. Failure to include a specialty modifier (GN, GO, GP), may result in the inability to process your claim.
Please be aware that providers will need to continue to ensure that the member has not exhausted his/her PT/OT/ST benefit and/or has a habilitative benefit prior to providing services.
We appreciate your participation and look forward to your assistance in assuring that Nebraska Total Care Health Plan members receive physical, occupational, and speech therapy services in a quality, clinically appropriate manner.
Provider education webinars to support this transition will be held beginning in March 2019. Webinar schedule and additional operational information will be forthcoming.
Should you have questions, please contact Provider Services at 1-844-385-2192 (TTY 711).
2/28/19 Update: To support this process transition Nebraska Total Care has scheduled provider webinar trainings for the following dates and times:
- March 11th, 2019 from 12 noon-1 pm
- March 13th, 2019 from 12 noon-1 pm
- March 15th, 2019 from 12 noon-1 pm
- March 25th, 2019 from 12 noon-1 pm
- April 19th, 2019 from 12 noon-1 pm
Please visit our Provider Training page for the specific training date notices and training connectivity information.
7/26/19 Update: Nebraska Total Care has completed the systemic updates related to authorizations for PT/OT/ST evaluations and re-evaluations and a reprocessing project for the impacted claims from April 1, 2019, forward has been submitted under the following project number: PROJ-77645498. This project has been added to our Known Issues Log under “Special Projects in Process”.