Does Medicare require pre authorization for therapy services

Pre-approval requests for therapy services

First Coast is continuing to receive the form “Request for pre-approval of therapy services above the $3700 threshold” for prior authorization of therapy services. In December 2012, First Coast notified providers that the prior authorization of therapy services ended December 17, 2012. First Coast asks that you discontinue submitting pre-approval requests for therapy services. All fax telephone lines for that project have been discontinued.

Claims for dates of service January 1, 2013, that are over the $3,700 threshold are subject to prepayment and/or post payment reviews.  Effective April 1, 2013, recovery auditors began the process of reviewing all therapy claims which have exceeded the $3,700 threshold for the year. When responding to additional documentation requests (ADR) for review of claims over the $3,700 threshold, submit the medical documentation to the following recovery auditor for jurisdiction 9.

Connolly Healthcare
Attention: Medical Record Department
555 North Lane
Suite 6125
Conshohocken, PA 19428

racinfo@connolly.com
866-360-2507 (telephone)
203-529-2995 (fax)