Physical Medicine Management Program

To help ensure that outpatient physical medicine services (physical therapy, occupational therapy and manipulation services) provided to our members are consistent with nationally recognized clinical guidelines, Highmark West Virginia has contracted with WholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC., to administer a registration process for physical medicine services as well as to provide medical necessity review and authorization, where applicable, for these services, effective with dates of service of Sept. 1, 2012, and beyond.

This page will serve as a reference source for providers to learn about the launch and implementation of this program. Check back often as additional information will be added on an ongoing basis.

Learn More About the Physical Medicine Management Program

Communications:

Please continue to look for future communications from us on this topic, and check the Plan Central page of NaviNet, Today’s Messages on the Provider Resource Center and upcoming issues of Provider News for additional tools and information to assist you in the program's authorization process.

Administrative Guide

Reference Materials

The following documents/forms include information that supports the Physical Medicine Management Program; the purpose of each is fully explained in the Administrative Guide above.

Clinical Criteria

Physical/Occupational Therapy

Manipulation

Outcome Assessment Tool

Reconsiderations and Appeals

Advisory Committee Meeting Minutes

Last updated on 10/16/2019

 

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