Published Date: Nov 06, 2023
As of February 1, 2024 Authorization requests via the Provider Web Portal (PWP) will require Medical Record Attachments
The Provider Web Portal has been upgraded to require documents to be attached to all authorizations requests. This will allow you to be more effective, self- sufficient and paperless!
In addition to the Authorization functionalities, you can also:
- Search Member Eligibility;
- Search and Print the status of referral requests;
- Search and Print the status of your latest claims and;
- Print EOP/RA reports for claims already processed.
Initial Evaluation Authorization requests
- Physician Prescription for Therapy services with Medical Diagnosis or Physician issued Referral Form for Therapy services with Medical Diagnosis.
- POC with medical and treating diagnosis signed/dated by the referring physician and/or Letter of Medical Necessity (LMN).
- The Plan of Care must include the evaluation and the start and stop dates.
- The Plan of Care must include the Signature of the referring Physician recorded on or after the recorded date of the treating Therapist.
- The therapist that develops the POC must sign and date the document on the date it is completed; and the treating therapists NPI must be included. The therapist must sign and date the POC prior to the PCP’s signature and date. The PCP may sign and date the POC on the same date the therapist signs and dates the POC.
- Standardized Assessment Scores clearly denoted and/or objective testing measures in Order to establish and support medical necessity.
Re-Evaluation Authorization requests
- Physician Prescription for Therapy services with Medical Diagnosis or Physician issued Referral Form for Therapy services with Medical Diagnosis.
- POC with medical and treating diagnosis signed/dated by the referring physician and/or Letter of Medical Necessity (LMN).
- The Plan of Care must include the evaluation and the start and stop dates.
- The Plan of Care must include the Signature of the referring Physician recorded on or after the recorded date of the treating Therapist.
- The therapist that develops the POC must sign and date the document on the date it is completed; and the treating therapists NPI must be included. The therapist must sign and date the POC prior to the PCP's signature and date. The PCP may sign and date the POC on the same date the therapist signs and dates the POC.
- Standardized Assessment Scores clearly denoted and/or objective testing measures in Order to establish and support medical necessity.
If any of the above elements are missing, TN will not approve the authorization request. Based on TN delegated responsibilities, the case will either be denied by TN or referred to the health plan with recommendation for denial. Failure to provide all required documentation could result in the delay of treatment of your patient.
Retrospective authorization requests will not be authorized after the treatment period has ended. Retrospective authorizations are requests for authorization of services that have already been provided to a member after a treatment certification period has ended.
CPT Codes applicable to the service request as well as ICD-10 codes are required for authorization approval.
Providers may submit authorization requests via the Provider Web Portal at https://asp.healthsystemone.com/hs1providers
If you have any questions you may contact your assigned Provider Relations Representative or you may speak to one of our Internal Provider Relations Reps (888) 550-8800 Option 2