American Specialty Health® (ASH) now manages the medical necessity review program for Cigna Healthcare–contracted providers who render physical therapy (PT) and occupational therapy (OT) services for customers with Cigna Healthcare commercial and Individual & Family Plans in certain ASH-managed markets.
This policy update only applies to PT/OT services performed in a provider’s office; it does not apply to those performed in an outpatient hospital setting.
What this means for you
PT and OT services that require a medical necessity review can be submitted either preservice or post-service. Submission of the clinical treatment plan is typically not required until after the patient’s fifth visit.
How to submit review requests
There are three ways to submit medical necessity review requests:
- ASHLink website: ASHLink.com.
- Fax: 877.248.2746.
- Mail: PO Box 509077, San Diego, California 92150.
Additional information
To ensure a timely review, requests should include the clinical treatment plan, necessary clinical information, and progress documentation.
ASH clinicians will review requests using evidence-based medicine and Cigna Healthcare coverage guidelines to determine medical necessity. Following the review, ASH will issue a determination to the requesting provider and Cigna Healthcare customer.
Coverage guidelines
The PT and OT coverage guidelines are available on the Cigna for Health Care Professionals website (CignaforHCP.com).
Learn more
Additional information is available on ASHLink.com. If you have questions, contact the ASH customer service department at 800.972.4226 (option 2).