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

• Physical Medicine Management Program Administrative Guide
  A complete guide for professional and facility providers detailing the requirements of the Physical Medicine Management Program

• Physical Medicine Management Program - FAQs
  Frequently asked questions for the Physical Medicine Management Program.

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.

• Physical Medicine Management Worksheet

Clinical Criteria

• Clinical Criteria - Physical Medicine

Physical/Occupational Therapy

• Utilization Management PT/OT Clinical Decision Support Tools
• Preauthorization Request for Physical/Occupational Therapy
  
  • Preauthorization Request Instructions - Physical/Occupational Therapy

Outcome Assessment Tool

• The Patient-Specific Functional Scale
  
  • Patient-Specific Functional Scale

Reconsiderations and Appeals

• WholeHealth Networks, Inc. UM Department Request Form