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Western Massachusetts Physical Therapy, P.C. takes most of the burden off of you when processing medical claims. WMPT realizes you have enough to do in just getting better and you do not need to be troubled by insurance claims. This all being said, the following is a guideline as to what will occur with your type of insurance.

Motor Vehicles

MVA’s are becoming harder and harder to collect. The key is co-coordinating the MVA with your health insurer. Attorneys will help you co-ordinate the insurance maze.
  • Get all MVA info from Personal Injury Protection (PIP) carrier (this pertains to Massachusetts Only). This means that the 1st $2,000.00 comes from your MVA insurer. Upon verification you should find out how much PIP coverage you have.
             Get other insurers (person who hit your car) info if possible. Also known as the BI – Bodily Injury claim
  • Get all Health information and follow all guidelines
             If HMO , initiate referral and follow-up and make sure all the visits are covered by a referral
  • If you get a PIP exhaust letter send it immediately to Western Massachusetts Physical Therapy (WMPT) so that we can bill the health.

HMO’s, such as Harvard Pilgrim, Tufts, BCBS and Health New England

All HMO’s require a referral. All guidelines must be followed. Make sure you know your copay and deductable and if there is a deductable how much has been met.

The initial comes from the Dr’s office and all further treatment has to come from HPHC. The visits and length of stay varies from contract to contract.

Initial visit counts as a visit.
PCP Dr. authorizes 1st to the 8 visit.
Before the 9th visit is used, and if needed, WMPT will fax clinical review for more visits up to a max of 30. They must respond within 48 hours

After 8th visit (including the initial eval, remember the initial eval is considered a visit) the WMPT has to get a re-authorization by submitting the Short-Term Rehabilitation Therapy Extension Request Form for Physical Therapy.

Health New England
25 visits or 2 months per condition per calendar year or 90 consecutive for acute episode per calendar year


All Workers comp must have an adjuster approve the claim. The adjuster will give a Initial Eval approval, then WMPT will need to ask her/him how to follow through with the rest of the claim. WMPT must have approval from a case manager for further treatment. If the accident occurred in Massachusetts, the claim will follow Massachusetts guidelines and be paid under Massachusetts W/C rates


Right now you have to keep track of the cap that is place $1840.00. This means you are allowed up to $1840.00 of approved treatment. It does not matter what we bill and only matters what Medicare approves. You should keep track of this because there are no more exceptions unless Congress puts forth emergency legislation. Sub-section – Home Health, You need to identify if you are under the Home Health agency for treatment. This usually happens if you have been in the Hospital within the last 90 days.

MISCELLANEOUS - All misc indemnity programs

When calling all misc health insurers you not only need to get all information you will need to go further and find out
  • Group Number as well as individual ID#
  • Are there any codes not allowed to bill
  • Are there any codes mutually exclusive. This means I can not bill say 97140 with 97110. (we will need to know this)
  • Do you pay me or WMPT?

Mass Health

Possibly a referral and 20 visits per Julian year

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