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Elizabeth M. Whitehorn, Director

Provider Notice 08/18/14

New Therapy Prior Approval Form

To:​ Enrolled Physical, Occupational and Speech Therapists, Physicians, Advanced Practice Nurses, Health Departments, Fee for Service Hospitals, and Rehab Hospitals​
​Date: ​August 18, 2014
​Re: New Therapy Prior Approval Form​

The department has developed a new form (HFS 3701T) Therapy Prior Approval Request Form (pdf) dedicated to prior approval requests for physical, occupational and speech therapy. Effective with the date of this notice, HFS will require that providers submit this form for therapy services that require prior approval.

Please note: Providers will no longer be required to submit the HFS 1409 Prior Approval Request (pdf) form for prior approval of therapy services. Also, this form does not apply to therapy services requested by a home health agency.

The new form is available in a PDF-fillable format on the department’s Medical Programs Forms page.

Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565, option 5, option 2.

Theresa A. Eagleson, Administrator

Division of Medical Programs