Insurance, Referrals and Authorization
Children's Health Care Associates (CHCA) participates with most insurance carriers. If you are not sure whether CHCA participates with your insurance, please call the member service number on the back of your insurance card to verify. If you need to make payment arrangements, please call CHCA at 215- 567-2422.
Referrals/authorization for neurology
If your insurance requires referrals or authorization, please request them from your child's primary physician.
Referrals/authorization for the neurologist should be made out to CHCA/Neurology for evaluation and treatment. Your primary physician may require an NPI number for the referral. That number is 1205991361.
If your child requires additional laboratory studies and/or X-rays, you should have a separate referral made out to The Children's Hospital of Philadelphia or to the facility where your child will have the tests done.
Referrals/authorization for occupational and physical therapy
During your visit to the MS Clinic, your child may be seen by an Occupational Therapist and/or a Physical Therapist.
Occupational and physical therapy services:
- Are separate from the physician services your child will receive
- May have separate co-pays or co-insurance for each
- May need a separate authorization and/or referral for each
- May require greater out-of-pocket expenses
Please contact your insurance company in advance to obtain the specifics of your child’s occupational and physical therapy benefit.
You will need the following information to verify the correct benefit detail when you call your insurance company:
- Let the insurance know that occupational and physical therapy services provided will be institution or facility based – NOT office visit.
- You may be asked for the following numbers in order to identify if CHOP OT and PT providers participate in your child’s health insurance, and whether they’re considered in-network or out-of-network:
||CHOP NPI #
||CHOP Provider #
||CHOP Tax ID #
|Horizon BCBS of NJ
|Blue Cross Blue Shield PPOs
||CHOP participates with our local BCBS PPO
- Although CHOP OT and PT may be in-network, we still might not be your capitated site (preferred site with lowest out of pocket expense for family). Please ask if you are capitated to another facility. If you are, you may only be able to receive OT and PT services at CHOP if you obtain a specific out-of-cap authorization.
- The procedure codes or CPT codes that may be used are:
- 97001 – Physical Therapy Evaluation
- 97002 – Physical Therapy Re-Evaluation
- 97003 – Occupational Therapy Evaluation
- 97004 – Occupational Therapy Re-Evaluation
- If services require a referral, this is obtained directly from your child’s primary care physician.
- If services require an authorization, out-of-cap authorization, or precertification, your child’s primary care physician will obtain this directly from your insurance company.
- For questions regarding insurance related to OT and PT in the clinic please call 267-426-5358.