What documentation does Qualis need?
Standard OT/PT Outpatient Treatment Submit electronically using the Qualis iEXCHANGE system (www.qualishealth.org). OR Fax submission to Qualis: • A Review Request Form (www.qualishealth.org). AND • A Physical/Occupational Therapy Questionnaire (www.qualishealth.org). Work Conditioning Electronic submission: Not available for work conditioning requests. Fax submission to Qualis: • A Review Request Form (www.qualishealth.org). • Attending physician request for work conditioning OR Signature agreeing with therapist’s recommendation. • Evaluation or Progress Report. • Performance based physical capacities evaluation. OR • Clinic progress reports (latest and 1 prior report). OR • Work conditioning evaluation. Make sure your documentation includes: • Plan of care (POC) to address the gaps in worker’s current abilities and what’s required to return-to-work and • Anticipated duration and visits for total POC and • Worker’s prognosis for meeting goals. Qualis may recommend a work conditioning
