Capital BlueCross has partnered with a new vendor, Landmark Healthcare Services, Inc. (Landmark Healthcare), for in-area outpatient physical and occupational therapy (PT/OT) utilization management services effective January 1, 2010.

WHAT THIS MEANS TO YOU AS AN EMPLOYER?
Landmark Healthcare is a national specialty benefit management company that Capital BlueCross selected based on its evidence-based approach to effectively managing outpatient physical and occupational therapy benefits. Specialty vendors like Landmark Healthcare offer such benefits as nationally-tested proprietary clinical practice guidelines and peer reviewers, all features that contribute greatly to a successful program and benefit management. Landmark Healthcare is also approved by the Pennsylvania Department of Health to operate as a certified review entity and conduct utilization review on behalf of Pennsylvania managed care plans.

Practitioner seminars have been held in various locations within the 21-county service area to introduce providers to the Landmark Healthcare staff and their utilization management program. Provider relations consultants contacted facility-based providers to explain the program.

Letters were sent to Capital BlueCross physical and occupational therapy providers notifying them of the new utilization management program through Landmark Healthcare.

PT and OT requests from out-of-network or out-of-area providers will continue to be managed internally by Capital BlueCross Medical Management staff.

Additionally, a change in benefit year PT and OT visit maximums will be implemented upon renewal beginning February 1, 2010.

Therapy Limits
For the purpose of managing appropriate utilization of therapy services, visit limits will be set at 20 visits per benefit period for Physical Medicine, Occupational Therapy and Respiratory Therapy and 12 visits for Speech Therapy. These new limits become effective with renewals on or after February 1, 2010.

WHAT SHOULD I DO NEXT?
Please communicate this important information to your enrolled employees.

If you have any additional questions regarding the information within this eCommunication, please call Corporate Synergies at 1.866.CSG.1719 or click CLICK HERE to contact us today.

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