MAC/FI Links Below for the Manual Medical Review process.

Functional Pathways’ training will begin the week of September 10th.

Palmetto: Palmetto Outpatient Therapy Caps and Threshold Process

CGS: CGS Therapy Cap Exception

Cahaba:   Cahaba GBA Manual Medical Review Process of Therapy Claims

First Coast:  First Coast Pre-approval process

Novitas: Novitas-Solutions Manual Medical Review of Therapy Services  **”Novitas Solutions’ dedicated information center for the transition of Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas workloads into MAC JH.  NOTE: Providers physically located in states outside the JH area, but processed currently by Pinnacle Business Solutions, Cahaba Legacy Part B, or TrailBlazer will be transitioned to Novitas as part of the JH implementation”.

Noridian: Noridian Therapy Threshold Manual Review

WPS:  WPS Therapy Cap Exception Preapproval Request

NGS:    NGS Instructions below:

  • Scroll down left side;
  • click on ‘medical review’;
  • click on ‘Therapy Limitation and Manual Medical Review Process for Therapy Threshold’

NHIC: NHIC Therapy Cap Exception Process


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