In order to begin services, Prainito Pediatric Therapy requires the following documentation and forms:
1. Prescription from your pediatrician or specialist, specifying OT services (i.e. Evaluation and/or Treatment with specific start and end dates) with child's DOB and diagnosis with ICD number if possible
2. Insurance information, copy of the front and back of card
3. Current IEP or IFSP if child is Medicaid, Peachstate, or Amerigroup
4. Any recent evaluations
5. Prior approval from insurance company/medicaid
6. These forms (7) filled out, signed and dated:In order to begin services, Prainito Pediatric Therapy requires the following documentation and forms:
Once an appointment is set, your child will be evaluated and a report with a Physician's Plan of Care and Letter of Medical Necessity will be written and sent to your pediatrician for his signature. They will need to sign and return this along with a prescription for ongoing OT treatment (like the above prescription for OT evaluation) to Prainito Pediatric Therapy. If a prior approval is required from your insurance company (and most do), before therapy is to begin, that will be obtained by the office, and then therapy can begin.
A Word About Medicaid Prior Approvals
As you know Medicaid is making it increasingly difficult for families to access Medicaid as funding source. Therapeutic intervention over eight units per month (2 hours of OT) requires a prior approval form the Department of Community Health. This prior approval can not be done retro-actively. The request for approval is submitted on line by Prainito Pediatric Therapy. The online submission takes approximately 30 minutes per child to complete. In addition, very specific support documentation must be faxed to DCH within five days of the online submission, or the request is automatically denied. All support documentation will be submitted by Prainito Pediatric Therapy. Support documentation that is required by DCH includes but is not limited to:
• A prescription, dated no more than 6 months ago, that specifically states the child’s name, diagnosis, therapy and CPT code(s) to be received, duration of session and length of time child is to receive therapeutic intervention not to exceed 6 months. Please note that DCH will NOT approve a prescription signed by a Physician’s Assistant or Nurse Practitioner.
• Letter of Medical Necessity/Physician's Plan of Care. This is a document that is supposed to be initiated by each child’s physician. However, DCH is very specific as to what the document must include and the document has to be re-done every six months. In order to insure that the document is prepared properly and timely, your Prainito Pediatric therapist prepares a new document for your child every six months and the office submits it to your child’s physician for them to sign and return.
• Current IFSP for children under 3 or IEP for children over 3 or signed letter of attestatio indicating that your child does not have either an IEP or IFSP (located above). Please note that DCH wants to see the part of these documents that list the therapeutic intervention being received. A progress update report from the school system does not list what therapeutic services are being received at school. Children that attend private school or that are home schooled need a note from their child’s school or parent that they attend private school or that they are home schooled and therefore do not have an IEP.
• Recent therapy notes, evaluations, progress updates.If your child is receiving therapy services through another therapy group, prior approval submissions must be coordinated with the other group.
Help in keeping track of your child’s Medicaid unit availability and expiration date. So if any changes occur, please notify the office immediately.
The office staff is more than happy to help with getting the correct information and forms filled out correctly, and obtaining PA so that there is no delay in starting therapy.