Page 62 - R2P Front Desk Manual v1

● All Medicare patients must have a referring physician attached to their case; they do
not necessarily need to have a referral.
○ Initial Evaluations, Progress Notes, and Plans of Care must be faxed to the Dr.
attached to the case. The PT should automatically fax these notes upon
completion.
○ All Medicare evaluations need to be signed off on by their physician, returned to
the clinic, and uploaded to the patient’s chart for record.
● Note: If Medicare is the secondary insurance, the cap for PT does not apply (per Stacy
with WebPT).

Tricare:
● Humana Provider Portal
● Provider Line for Tricare/Humana: 800-444-5445, option 7 for a representative
● The patient’s ID number can be input as either their 9-digit SSN or 11-digit D.o.D.
benefits number found on the BACK of their card (not the 10-digit benefits number listed
on the front of their card). Do not enter the ID number with any dashes.
● Referral with authorization is required from the patient’s PCM for Tricare Prime.
The referral must have R2P’s provider information & the correct treating address.
○ Tricare Select does not require a referral.
● In WebPT: insurance carrier Tricare Prime/Select = Tricare East
○ Tricare for Life is used when plan is secondary
● SCHEDULING NOTE: PTAs cannot see Tricare patients because the clinic will not get
reimbursed!

United Healthcare:
● United Healthcare Online Portal
● Provider Services: 877-842-3210
● $70 is the standard rate to be collected for payment toward deductible (flat fee)
● All ID #’s will start with a “9 or 8”. If it starts with a 1, then it will need to be checked for
Medicaid (state-provided insurance).
○ Note: R2P does not participate with UnitedHealth One plans, as most do not
have any benefits for PT.
● All group numbers must checked through Optum to determine if authorization is
required.
○ If UHC is the secondary insurance, Optum submission is not required.
● When verifying UHC insurance, you must check to see if the plan is MDIPA. If it is, then
the patient MUST have a physician referral for the first (up to) 8 visits. The Dr.’s name
on the referral must match the PCP that is linked to their insurance plan (PCP’s name
can be found when verifying patient information online through UHC, or ask the
representative).
○ Always call to receive benefits for MDIPA plans because auth is required
after the patient’s 8th lifetime visit PER BODY PART, so the clinic must know

Last Update: 7/9/19