Prior authorization required after threshold; submission via UHA portal

Prior authorization is required after 8 visits or 32 units combined occupational and physical therapy within a calendar year. All prior authorizations submitted will be reviewed for medical necessity. Submit requests via UHA's online portal; if you do not yet have a login, contact UHA at 808-532-4000 to establish one. Providers must confirm whether the patient has previously received PT/OT services from another provider when requesting authorization.

• Threshold: authorization required after 8 visits or 32 combined OT/PT units per calendar year.
• All submissions are subject to medical necessity review.
• Submission method: UHA online portal; phone 808-532-4000 to establish login.
• Provider must verify prior PT/OT services from other providers.

Prior authorization documentation: required elements of treatment plan

Documentation submitted for prior authorization must include an individualized, written treatment plan appropriate to the diagnosis and evaluation that clearly documents medical necessity, measurable objectives, specific procedures/modalities, and the frequency and duration of treatment. The treatment plan should state specific goals (including transition to home maintenance), provide a reasonable estimate of when goals will be reached, and be revised as the patient's condition changes; include evidence of prior PT/OT services when applicable.

• Individualized written treatment plan documenting medical necessity.
• Specific statements of goals, including transition from one-to-one supervision to home maintenance.
• Measurable objectives intended to facilitate meaningful functional improvement.
• A reasonable estimate of when goals will be reached.
• The specific procedures and/or modalities to be used (including those for a home maintenance program).
• The frequency and duration of the treatment.
• Treatment plan revisions as the patient's condition changes.
• Include evidence of prior PT/OT services when applicable.