Evolent is our partner that helps us manage our physical therapy benefits. At HMSA, we strongly believe that keeping health care affordable is necessary, and we’re committed to continuing to evolve our processes to decrease administrative tasks for your practice.

We’re working with Evolent on how to communicate your clinical performance data based on the medical claims in our system. This collaboration has led to the creation of a physical therapy analytics tool. Its goal is to leverage this data as a foundation to determine physical therapy Fast Pass awards.

Physical therapy providers will receive analytic reports of their performance and Fast Pass status. Please take the time to review and consider the report when received. Our Evolent partners will reach out to discuss the report and answer any questions you may have. You may also email us at HMSAProviderConcerns@Evolent.com.

The physical therapy program Fast Pass goes into effect on Aug. 1. To be considered for the Fast Pass program, providers must:

  • Provide physical therapy services for a minimum of 20 distinct HMSA members annually.
  • Maintain a combined clinical denial rate (full and partial) of <10%.
  • Maintain outlier score percentage of ≤8%.

Physical therapists under unique tax identification numbers who have met the criteria are eligible for a Fast Pass and aren’t required to submit prior authorization requests for physical therapy services. Provider performance will continue to be analyzed to determine continued Fast Pass eligibility every January and July.