Referral Process (for parents only)

Referral Process

ReferralProcessPic

 

Do you have Medicaid or CHIP? If so the following pertains to you…

  • All therapies require a physician/pediatrician referral from their most recent office visit prior to evaluating and treating your child. Click here (link to Referral form) for PDF version of the referral letter.
  • Once the Physician signs the referral requesting Physical, Occupational and/or Speech therapy along with the Diagnosis, it can be faxed directly to your closest Winter location.
  • The following insurance companies require prior authorization for initial evaluation – Superior Medicaid and CHIP and Texas Children’s Health Medicaid and CHIP. Contact your child’s Dr. office who signed referral as they will know the guidelines to follow of how to obtain a prior authorization. If your child does not have a Medicaid/ CHIP plan that requires prior authorization we are able schedule for the initial evaluation just by obtaining the signed referral by the physician.
    • Initial Evaluation Request: authorization MUST be submitted by the referring physician prior to evaluation, must include the name of the therapy entity to conduct the evaluation

    • The evaluation order must specify disciplines to evaluate and be signed by the physician (no stamp signatures) and specify the diagnosis and medical reasons for the evaluation

 

    • Must include the most recent complete medical checkup (as applicable, exams must be up to date in accord with the periodicity schedule).

 

    • Current developmental screen (within last 30 days) documenting significant delay in area of evaluation request (ASQ or PEDS).  Comment of assessment of normal intelligence

 

    • Include Provision for the home exercise program (HEP) with frequency that parent/caregiver is to perform the HEP.

 

    • Document current (last 6 months) hearing screening  for ages 0-3 years or current (past 12 months) 3 years 1 month to 6 years if request is for Speech Therapy addressing communication delays/deficits.

 

  • If your child does not have a Medicaid/ CHIP plan that requires prior authorization we are able schedule for the initial evaluation just by obtaining the signed referral by the physician.

 

  • Once prior authorization is approved Winter Pediatric Therapy is given 30 days to schedule the evaluation, the office will then contact you to schedule the requested Initial evaluation(s).

 

Getting you prepared for your first visit to our facility

Prior to your evaluation being scheduled, your primary insurance will be verified and, if necessary, prior authorization obtained.  If there is secondary insurance, that will also require verification and prior authorization.  It is suggested that you call the Member Service department at your insurance company and verify what your responsibilities may be regarding copays, deductibles, referrals, etc.  Please remember that benefits quoted are not a guarantee of payment per your insurance.

 

The scheduler will call to schedule your son/daughter’s evaluation.  At that time you should have a prescription from your physician to evaluate and treat your child.  Any questions regarding the scheduling of evaluations should be directed to the scheduler at the facility close to you.

 

Referral Process – Are you a private pay patient? If so the following pertains to you…

  • All therapies require a physician/pediatrician referral from their most recent office visit prior to evaluating and treating your child. Click here (link to Referral form) for PDF version of the referral letter.
  • Once the Physician signs the referral requesting Physical, Occupational and/or Speech therapy along with the Diagnosis, it can be faxed directly to your closest Winter location.
  • The scheduler will call to schedule your son/daughter’s evaluation.  At that time you should have a prescription from your physician to evaluate and treat your child.  Any questions regarding the scheduling of evaluations should be directed to the scheduler at the facility close to you.

 

When you arrive for the evaluation please come to the reception desk in the outpatient area and have with you:

  1. The script from your physician to evaluate and treat your son/ daughter
  2. Your insurance card(s).
  3. Any copays or referrals as required by your insurance company.
  4. Copy of driver's license/Identification Card of the parent or legal guardian.

 

Please have all of the above items with you when you arrive or it will be necessary to reschedule your appointment.