UH - Managed Care Office

Office of Managed Care Operations

Referral & Pre-Authorization Requirements for Physical Medicine & Rehabilitation Services

OUTPATIENT SERVICE

Managed Care Organization	Physical Therapy	Occupational Therapy	Speech Therapy
Aetna	Authorization Required	Authorization Required	Authorization Required
AMERIGROUP Community Care	Authorization Required	Authorization Required	Authorization Required
AmeriHealth, Inc. (Excluded OP service at UH.) See Note Listed Below	EXCLUDED SERVICE	EXCLUDED SERVICE	EXCLUDED SERVICE
United Community Plan (Formerly AMERICHOICE)	Authorization Required	Authorization Required	Authorization Required
Empire Blue Cross	HMO-Yes PPO- No POS (In-network) -Yes POS (Out-of-network)-No	HMO-Yes PPO- No POS (In-network) - Yes POS (Out-of-network) - No	HMO-Yes PPO- No POS (In-network) -Yes POS (Out-of-network )-No
Horizon Blue Cross & Blue Shield of NJ	Pre-Auth	Pre-Auth	Pre-Auth
Horizon NJ Health	Authorization Required	Authorization Required	Authorization Required

Note: AETNA All Outpatient Physical and Occupational Therapy performed in a Hospital must be authorized after the initial
evaluation visit. Speech Therapy does not require a Referral for HMO based plans and is a payable as direct access.

Note: AMERIGROUP No Precertification is required for coverage of E&M codes. All Other Services require precertification.
Outpatient Physical Therapy (PT) Occupational Therapy (OT) and Speech Therapy (ST) are covered by Medicaid FFS.

Note: Great West Health Care Contract Terminated with University Hospital as of June 29, 2008

Note: AMERICHOICE was Purchased by United HealthCare
& Name was changed to United Community Care

Note: AMERIHEALTH Inc. Insurance Contracted Terminated with University Hospital as November 9, 2010

Note: HEALTHNET Insurance Company Medicaid Products was Purchased By United HealthCare Insurance

Note: UNIVERSITY Health Plan Insurance Company No Longer Provides NJ Family Care Services in New Jersey as of December 31. 2010

Note: AETNA Beginning August 12, 2011 if the referring Physician does not obtain precertification,

Aetna will no longer cover at the in-network benefits level for services provided by nonparticipating
Radiologists, Pathologies, Anesthesiologists, and Independent Laboratories

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