Get Therapy Preapproval Form - Wptaorg - Wpta

This guide provides a comprehensive overview of how to fill out the Therapy Preapproval Form efficiently. Follow the step-by-step instructions to ensure your submission is complete and meets all necessary criteria for preapproval.

Follow the steps to fill out the Therapy Preapproval Form online

1. Press the ‘Get Form’ button to obtain the form and open it in the editing interface.
2. Complete the patient information section by filling in the patient’s last name, first name, middle name, Medicare number, birth date, and address.
3. In the ordering/referring provider information section, enter the ordering/referring provider's name, provider number, address, and NPI number.
4. Provide the performing provider information by entering the performing provider's name, provider number, address, and NPI number.
5. Select the requested therapy services by checking the appropriate boxes for PT (Physical Therapy), OT (Occupational Therapy), and ST (Speech Therapy). Then, indicate the number of therapy days requested.
6. Specify the date range for services by providing the start and end dates.
7. Detail the planned services in the provided space, ensuring to be as descriptive as possible.
8. Enter the requestor's name, phone number, and fax number in the designated fields.
9. In the justification section, include the condition and/or diagnosis being treated and a narrative explanation detailing the necessity of the services requested.
10. Gather any necessary supporting documentation like evaluation reports or treatment notes and ensure they are ready to be submitted with the form.
11. Finally, save your changes, and download, print, or share the completed form and supporting documents as required.

Begin the process now by filling out your Therapy Preapproval Form online.