Physical Medicine Management Program

To help ensure that physical medicine services (physical therapy and occupational therapy) provided to our members are consistent with nationally recognized clinical standards, Highmark Delaware contracts with WholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC., to administer a registration process for physical medicine services. WHN also provides medical necessity review and authorization, where applicable, for these services. This program took effect for dates of service of March 1, 2014, and beyond.

The program applies to Highmark Delaware's PPO, EPO and IPA plans and its requirements will be waived for Highmark Delaware's indemnity; comprehensive; Medicare Supplement, Complementary and Carve-out products; and for BlueCard® and Federal Employees Health Benefits Program (FEP) members.

The implementation of this Physical Medicine Management Program was due in large part, to increasing demands from our employer group customers for products that promote quality, medically appropriate care and value for their employees. In addition, the goal is to ensure that physical medicine services are clinically indicated, medically necessary, follow established treatment standards and are in accordance with member's benefit coverage.

Learn More About the Physical Medicine Management Program

Communications:

Please continue to look for future communications from us on this topic, and check the Plan Central page of NaviNet, Today’s Messages on the Provider Resource Center and upcoming issues of Provider News for additional tools and information to assist you in the program's authorization process.

Administrative Guide

A complete guide for professional and facility providers detailing the requirements of the Physical Medicine Management Program.

Frequently Asked Questions

Reference Materials

The following documents/forms include information that supports the Delaware Physical Medicine Management Program; the purpose of each is fully explained in the Administrative Guide above.

Clinical Criteria

Physical/Occupational Therapy

Outcome Assessment Tool

Reconsiderations and Appeals

Education

The training module below includes audio. Please ensure that your speakers are adjusted accordingly.

Advisory Committee Meeting Minutes

Last updated on 11/1/2018

 

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