Welcome to Triad Healthcare a MedSolutions Company


Please note, effective July 1, 2017, eviCore will cease processing Soonercare prior authorizations. Should you have any questions, please contact the Soonercare Help Line at 800-522-0114.


OHCA THERAPY MANAGEMENT PROGRAM

Effective July 1, 2014 in an effort to continuously improve the quality of care delivered to OHCA's membership with quality initiatives to support evidenced-based patient care, OHCA has partnered with Triad Healthcare a MedSolutions company, to administer a prior authorization program for Physical Therapy, Occupational Therapy and Speech Language Pathology for outpatient services.

Effective July 1, 2015, therapy services delivered in schools will require prior authorization.

1. To work with you and your staff to efficiently receive your prior authorization requests and any medical records necessary to perform a review of medical necessity and ensure that these reviews are performed correctly and that you receive a response from Triad in a timely manner.

2. To provide actively practicing same specialty providers who will review compliance between requested procedures and evidenced-based medical policies, using current clinical standards of care, on a case-by-case basis.

3. To make same specialty peer reviewers available to you to discuss prior authorization determinations to:
  a. Clarify and explain clinical rationale, clinical logic and the medical evidence used in the determinations.
  b. Discuss unique needs of an individual patient or clinical scenario.
  c. Collaborate on clinical best approaches when multiple evidence based treatments are identified.


All previous outpatient authorizations rendered by OHCA for patients in a current course of care for dates of service extending beyond 7/1/14 will be valid. Prior authorization thru Triad will be required for subsequent requests for continuation of care if necessary.

PHYSICAL AND OCCUPATIONAL THERAPY MANAGEMENT PROGRAM

Triad will begin processing prior authorization requests for Physical and Occupational Therapy services delivered in schools for dates of services on or after July 1, 2015.

Triad will begin continue processing prior authorization requests for outpatient Physical and Occupational Therapy for dates of service on or after July 1, 2014.

Prior authorization is not required for the initial evaluation. All therapy services following the initial evaluation must be prior authorized for continuation of service. Prior to the initial evaluation, the therapist must have on file, a signed and dated prescription or referral for the therapy services from the member's physician. This signed and dated prescription or referral must be sent with medical records along with the prior authorization request.

PROCEDURE CODES: Effective July 1, 2014 the following procedure codes require prior authorization: Click here for list of procedure codes.


SPEECH LANGUAGE PATHOLOGY MANAGEMENT PROGRAM

Triad will begin processing prior authorization requests for outpatient Speech Language Pathology for dates of service on or after July 1, 2015.

Triad will begin continue processing prior authorization requests for outpatient Speech Language Pathology for dates of service on or after July 1, 2014.

Prior authorization is required for the initial evaluation and all therapy services following the initial evaluation. Prior to the initial evaluation, the therapist must have on file a signed and dated prescription or referral for the therapy services from the member's physician or other licensed practitioner of the healing arts. This signed and dated prescription or referral must be sent with referring providers' medical records indicating the need for the speech therapy evaluation along with the prior authorization request.

PROCEDURE CODES: Effective 7/1/14, the following procedure codes require prior authorization for outpatient services and effective 7/1/15 these codes will require prior authorization for therapy services delivered in schools. Click here for list of procedure codes.

OHCA requires prior authorization be obtained before the services are delivered. If the services do not meet medical necessity as defined in the medical policy, the claim will be denied.

PRIOR AUTHORIZATION: Prior authorization form can be accessed by clicking here: Therapy Management Authorization Fax Form

Please reference the following link below with instructional information provided for the completion and submission of new prior authorization form. SoonerCare Therapy Mgmt. Authorization Fax Form - Instructional Document

CHANGE OF PROVIDER: When member has an approval for services and wants to switch providers or changes school districts, a new prior authorization request from the new provider must be submitted along with a change of provider request form (SC- 16). For children, this form must be signed by the parent or legal guardian. The form can be accessed by clicking here:
  English:  Change of Provider Request
  Spanish: Change of Provider Request

PARENTAL CONSENT: For the childhood population, a parental consent form is required and must be sent with the medical records. This form can be accessed here :
  English:  Parental Consent Form
  Spanish: Parental Consent Form

SUBMISSION PROCESS: Prior authorization requests, along with the patient medical records, may be submitted using Triad's secure provider portal or via fax at (888) 328-3662. Requests for therapy services delivered in schools can be submitted using Triad’s secure provider portal or via fax beginning 6/15/2015. Triad's secure provider portal is an easy and efficient way for you to manage your prior authorizations. Click here to register.

Registration link will be active starting 6/15/2014

MEDICAL POLICIES: Triad Medical Policies are posted online here.

PROVIDER FREQUENTLY ASKED QUESTIONS: Frequently asked questions are posted here.

QUICK REFERENCE GUIDE: Quick reference guide for the Therapy Mangagement Program is posted online here.

CLINICAL DOCUMENTATION CHECKLIST: The Speech Therapy Checklist and
Physical/Occupational Therapy Checklist provides a list of clinical documentation that is
required when submitting a prior authorization request for therapy services.

PROVIDER ORIENTATION TRAINING: The provider orientation training presentation for school-based services is available online here. If additional training is needed please contact the Client Services Delivery Team.

CLIENT SERVICES DELIVERY TEAM: The client service delivery team is responsible for overall service delivery not only to our health plan clients, but to the rendering providers. For questions that are not about a specific case, contact Client Services at clientservices@medsolutions.com or (800) 575-4517.

GENERAL INFORMATION
For assistance with our Therapy Management program or a specific case, please contact our customer service team at (888) 693-3281 . Please select Option 2 from the main greeting to be transferred to a representative who can assist with your Physical, Occupational, and Speech Therapy related inquiries. Our customer service team is available Monday through Friday from 8AM – 6PM, CST