Effective April 1, 2017, Group Health Cooperative of Eau Claire will require Prior Authorization for Cardiac
and Pulmonary Rehabilitation. Therapy requests must include the entire scoring scale including the
standard scores and the members score. The Outpatient Therapies section of our Prior Authorization
Guidelines will now read as below. For an updated copy of the Prior Authorization guidelines and
Authorization request forms, please visit our website at www.group-health.com.
Medically necessary outpatient therapy (when a covered benefit) must be prescribed by a physician
Physical Therapy & Occupational Therapy
Prior authorization from the Cooperative is not required for the first six outpatient visits, including the
initial evaluation, for physical therapy and occupational therapy. All therapies must be medically
necessary. If upon review medical necessity criteria are not met, the Cooperative may recoup payment
for non-medically necessary services. If additional visits beyond the first six are needed, prior
authorization is required before the seventh visit.
Use the PT/OT Request form.
Prior authorization is required for speech therapy. Many commercial benefit plans do not cover speech
therapy. If speech therapy is a covered benefit, prior authorization is required for any subsequent visits
after the initial evaluation.
Use the Speech Therapy Request form.
Cardiac Rehabilitation & Pulmonary Rehabilitation
Prior authorization is required for Pulmonary and Cardiac Rehabilitation prior to any services being
Use the Cardiac & Pulmonary Rehabilitation Request form.
If you have any questions or concerns, please contact Stacey, Janice or Carol in Provider Relations at (715) 552-4300.