Physical, Occupational or Speech Therapy Services Concurrent Review Forms
Provider Type
- Physicians
- Hospitals
- Participating Physician Groups (PPG)
- Ancillary
Providers must use the Urgent Request for Continuing Occupational, Physical or Speech Therapy (PDF) concurrent review form for HMO/POS, PPO, EPO, and Medicare Advantage members continuing physical, occupational or speech therapy and home health services. Completed forms must be faxed to the Health Net Prior Authorization Department.