These changes will result in a much faster response to all your treatment plan requests. To maintain privacy while completing this form, you'll have to login with your PIN number to access the form on GHI's secure server. If you don't already have a PIN, you can Apply for a PIN at Provider Online Services . New procedure changes for handling Benefit Extensions Benefit extension requests will be returned and not processed, unless the Treatment Plan form is completed.
Full instructions accompany the form.
All authorizations will be indicated directly on the Treatment Plan form, in the space provided For GHI Use Only, and returned to you via fax or email. All non-authorizations will contain a clinical rationale for the determination, and will provide the appeal procedure. This information will be sent to you via mail. Visits must be utilized according to the time specified in the determination. Extensions will not be considered, unless the Treatment Plan form has been appropriately completed with clinical information to establish medical necessity.