Physical Medicine Management Program

To help ensure that physical medicine services (physical therapy and occupational therapy) provided to our members are consistent with nationally recognized clinical standards, Highmark Delaware contracts with WholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC., to administer a registration process for physical medicine services. WHN also provides medical necessity review and authorization, where applicable, for these services. 

The program applies to Highmark Delaware's PPO, EPO and IPA plans and its requirements will be waived for Highmark Delaware's indemnity; comprehensive; Medicare Supplement, Complementary and Carve-out products; and for BlueCard® and Federal Employees Health Benefits Program (FEP) members.

Administrative Guide

Reference Materials

The following documents/forms include information that supports the Delaware Physical Medicine Management Program; the purpose of each is fully explained in the Administrative Guide above.

Clinical Criteria

Physical/Occupational Therapy

Outcome Assessment Tool

Reconsiderations and Appeals

Last updated on 9/30/2022 9:44:24 AM

 

*This program began on March 1, 2014.

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