Posted May 14, 2025

Providers are reminded that when submitting an authorization request for an existing patient to treat a new condition or body part, the submission will be considered a new prior authorization request.

A printable PDF is available here.

Key Considerations:

Each request for a new condition or body part requires a separate review and approval process, regardless of the patient’s treatment history.

Authorization requests for a new condition or body part will:
- Not be considered a continuation of prior treatment.
- Not be treated as an appeal of a past denial for a different condition or body part.

Providers must ensure that all necessary documentation specific to the new condition or body part is included with the request to avoid delays and help expedite the authorization process.

Submission Process:

If the authorization period has not expired:
- Submit the authorization request via fax.

If the authorization period has expired:
- Submit the request via Healthfirst’s Provider Portal through Availity Essentials^TM
- Select “Request a new authorization.”

Required Documentation:

Initial evaluation specific to the new body part.
Referral from the Primary Care Provider (PCP) specific to the new body part.

Questions?

If you have questions, please contact your network account manager, or Healthfirst Provider Services at 1-888-801-1660, Monday to Friday, 8:30am–5:30pm

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).

May 2025

Authorization Requirements for Additional Physical and Occupational Therapy Visits for New Conditions or Body Parts

Key Considerations:

Submission Process:

Required Documentation:

Questions?

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