Many of you know that Magellan Hawaii will take over physical medicine (physical therapy, occupational therapy, and chiropractic) utilization review for Hawaii insurance provider HMSA on January 1, 2023. APTA Hawaii Payer Relations Committee Co-Chairs Patti Taira-Tokuuke and Shawna Yee met with reps from Magellan Hawaii to get clarification about the transition. See the key take aways they gleaned from the meeting and subsequent discussion below. These take aways expand on information provided in the Magellan Hawaii Tip Sheet and Checklist. Also, you may find a link to Magellan Hawaii’s schedule of online trainings during December and January here.
- You will use Magellan Hawaii’s portal at RadMD.com to submit prior authorization requests and will need to create an individual provider account in order to do so.
- Each provider must have their own log-in account – but providers within the same clinic may use the same email address.
- Office staff, as well as clinicians, may sign up for accounts.
- If you were an “autonomous provider” in the eviCore system, you will continue in a similar status until June 30, 2023 – except the Magellan Hawaii system will call it a “fast pass.” And except for signing up for an account on RadMD.com, you will not need to submit requests for prior authorization.
- Magellan Hawaii will group all providers practicing under the same tax ID in the same tier.
- Magellan Hawaii will reassess provider tiers every six months.
- Although Magellan Hawaii takes over on January 1, 2023, if you have an eviCore authorization received before January 1 that will expire in January, Magellan will honor the authorization through January.
- There will be a 10-day window after a patient starts PT to get an authorization and Magellan will back date the authorization to the 2nd visit. There will be some flexibility in this 10-day timeline during January.
- Once you submit your request for authorization, the RadMD portal will either automatically generate approval for a certain number of visits or will request additional information and your prior authorization request will be placed in pending status.
- All first visits (eval and initial treatment) will be approved.
- If you receive authorization for visits, you will need to accept or decline the authorization. Magellan Hawaii strongly suggests that you accept the visits so you can start treating the patient.
- The typical turnaround time on a pending request will be 2-3 business days. Your request will be reviewed by a PT. The most common reason that a request ends up in pending status is because additional documentation is needed.
- Magellan Hawaii will send authorizations by email or fax.
- To get paid for treatment, you will continue to submit your claims to HMSA.
Posted on December 1, 2022 by Chapter Staff
Originally Published in APTA Hawaii’s Monthly e-Newsletter – December 2022 edition