Public Announcements

 

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

PT/OT/ST Authorization Process Training Schedule

Specific Training Notices

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, TDD/TTY: 1-844-307-0342, Relay 711.

To support this process transition Nebraska Total Care has scheduled provider webinar trainings. Use the links below to see specific times and dates for trainings. 

PT/OT/ST Authorization Process Training Schedule

Specific Training Notices