Wednesday, 1 August 2012

How can we request authorization for Physical Therapy and Occupational therapy from US Dept of Labor Insurance?

All Prior Authorization requests must either be fax #1-800-215-4901 or be submitted through the Web Bill Processing Portal

We must be filled the below Data in the Authorization request sheet
  • Date Requested
  • Requested by
  • Phone
  • Case file #
  • Claimant’s Name
  • Claimant Date of Birth
  • Date of injury
  • Provider Name
  • ACS Provider Number
  • Provider Tax ID
Procedure Code Information
  • Date(s) of Service
  • Procedure CPT/HCPCS
  • Modifier
  • Units
  • Frequency
  • Duration
  • Total # of Units Requested
Treatment Plan Information
  • Body part to be treated
  • Side of body
  • ICD-9 code
Please remember to send prescription from attending physician and treatment plan with requests for physical or occupational therapy.  Please put Case File # on every page faxed.  Fax #800-215-4901.

You can find the Authorization template sheet in the below link


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