Changes Regarding Prior Authorization Review Requests

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Effective August 1, 2017, WSI will implement changes involving prior authorization review requests. The changes result from recent amendments made to the North Dakota Administrative Code (N.D.A.C.) § 92-01-02-33 and 92-01-02-34. Providers should be aware of the following:

  • The timeframe to submit a request for prior authorization to WSI will be changed from 24 hours to at least 72 hours or 3 business days. The Utilization Review Guide outlines services requiring prior authorization.
  • The number of physical or occupational therapy units billed will be limited to 4 per visit. This applies to the initial and post-surgical windows, as well as requests approved through utilization review. The limitation includes the total number of units billed for timed and non-timed codes. To request more than 4 units per visit, a provider should specify the number of units requested on the Utilization Review Request (UR-C) form.
  • The number of acupuncture visits allowed will be limited to 18 during the life of a claim.

  View N.D.A.C. 92-01-02 for the complete revision of these sections.

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