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FAQ from eviCore and AMTA – WA Email Exchange

Tuesday, January 30, 2018   (0 Comments)
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The training stated the initial evaluation will be authorized, but the first treatment is not guaranteed. Massage therapists do not conduct a separate evaluation visit prior to the first treatment. Will the first MT visit be authorized?

Yes, as long as the benefit is available, the initial massage treatment will be authorized. It is expected that a brief patient-centered evaluation is conducted with each massage treatment.

 

Are massage therapists expected to complete the specific assessments shown on the slides in the trainings? Is the massage therapy clinical pathway the same as the clinical pathway for other therapies?

There is a separate clinical worksheet and a clinical pathway unique to massage therapy. The Massage Therapy Clinical Worksheet is now posted at eviCore.com/healthplan/Premera under CorePath resources. The clinical assessments for massage therapy include: 0-10 Pain Scale, 0-10 Patient Specific Functional Scale, patient reported use of prescription pain medication, patient reported recurrences of condition within the past year.

On the top of the Massage Therapy Clinical Worksheet, it states that urgent same day requests must be placed by phone. What does this mean for massage therapy requests?

This does not change the allowed time frame for a pre-authorization request. For Premera, retrospective requests are still allowed according to the health plan’s rules. This message is on all of our clinical worksheets and refers more to urgent care
situations that may need authorization for same-day procedures. Massage therapists always have the option to place requests online or by fax, phone is never strictly required for massage therapy. Massage therapists should submit treatment requests
with their preferred method. If you are placing a same-day request that is not immediately approved, you can request a peer-to-peer online or by phone.

 

Will we have the option to provide additional clinical information if the case is eligible for an instant approval?

No, additional clinical information will not be collected if an approval can be reached upon pathway completion. Because most Members will be able to return to optimal function after the first couple of authorization periods, eviCore purposely designed the
initial and follow-up pathways to only collect enough information to determine clinical severity, complexity and response to treatment received. Providers who believe ongoing care is still necessary after utilizing the visits approved from the first and
second request, may request additional visits and include any other clinical information they would like considered to further explain why their patient’s condition is unique. These submissions will be routed to an eviCore same-specialty reviewer who will take into consideration all additional clinical information supplied before rendering a determination.


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