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Blue Advantage will reimburse individual therapist for services rendered according to the member benefits with a $25 copayment required per visit. Therapists must submit precertifications for therapy services rendered to patients beginning with the 15th visit. This process should not be initiated prior to the 14th visit. Services that are not precertified will be denied and the member will be held harmless.
Hospitals and Skilled Nursing Facilities (SNF)
Precertification for therapy services is not required for hospitals and skilled nursing facilities. These claims (physical therapy, occupational therapy and speech therapy) will process with a co-payment per visit for Blue Advantage participating facilities. The amount of the co-payment will be determined by the benefit option under which the member is covered.