Changes Regarding Prior Authorization Review Requests

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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