Benefits are subject to the following guidelines:
- Limit of 20 visits allowed per calendar year without certification (refer to Speech Therapy for certification exception information). Maximum of 60 visits allowed per calendar year.
- Treatments that exceed 20 visits per calendar year must be referred to HCMU for review. Manipulative therapy performed by an osteopath or medical doctor is also subject to these guidelines.
Referral forms for chiropractic, physical medicine, occupational therapy, physical therapy and speech therapy are completed and submitted to HCMU to initiate the certification process. The professional consultant can subsequently request additional documentation from the provider. The appropriate forms are available online.
The following information is required on the referral form:
- Summary of the case.
- Approximate length of time treatments will be necessary.
- Long- and short-term goals.
The following information may be requested by the professional consultant to support medical necessity:
- Complete treatment plan.
- History and physical.
- Assessment of the patient’s response to treatment as determined during the initial examination and reevaluation.
- Progress notes.