Non Participating Practitioner Claims Packets

 How to Obtain Verification of Medical Necessity for Physical Medicine Services Rendered by Non-Participating Practitioners

If your program requires verification of medical necessity for all physical medicine services and any additional services that are provided on the same day as a physical medicine service rendered by non-participating practitioners, then coverage is limited to those services that are verified as medically necessary.

Send clinical documentation to verify the medical necessity of care to American Specialty Health Group, Inc. (ASH Group) for peer review.

You can do this by either:

Option A:

Obtain your medical records yourself for the dates of service you want verified as medically necessary and send that information by fax to the fax number below or by mail to ASH Group at the address below. The medical records should include any intake forms you completed in the practitioner’s office describing your condition as well as copies of any examination forms used in assessing your condition or progress. And, tell us what dates of service you want us to review. These dates should be the first and last visit dates on the claims submitted.

Option B:

Ask your non-participating practitioner to communicate directly with ASH Group to verify medical necessity. If your practitioner is willing to do this on your behalf, we have developed reporting tools for your practitioner to use. The practitioner can assist you in meeting your obligation to obtain medical necessity verification bysubmitting copies of your medical records when billing for a service listed on the CPT Code list. All services provided on the same day as a CPT Code on this
CPT Code list should be included in the submission to ASH Group.

To ensure expedient processing submitted medical records MUST contain the following information: Patient and practitioner demographics, treatment/services rendered, appropriate outcome assessment results, patient complaints, any pertinent history and diagnoses, along with the clinical evaluation to support any diagnoses . He or she may fax the forms to ASH Group at the number below or mail the forms to the address below.

ASH Group Customer Service agents are available Monday through Friday from 5 a.m. to 6 p.m. Pacific Time at 800.972.4226 to assist you and answer any questions.

Sen d the necessary information to:
American Specialty Health Group, Inc.
Claims Administration 
P.O. Box 509001
San Diego, CA 92150-9001

Fax: 877.248.2746