Humana Orthonet Form
More than 900 of the nations leading health plans hospitals and healthcare organizations are demonstrating their commitment to high quality provider data and simplifying provider data collection by using caqh proview.
Humana orthonet form. 6 13162 0 4. Outpatient physical occupational and speech therapy management program. 13 20413 1 4. Humana pain management prior authorization request form please complete and fax this request form along with all supporting clinical documentation to orthonet at 1 888 605 5345.
Denied for no authorization on file revised 122012 c. An orthonet physician may contact the requesting. 2 13162 0 4. As of january 1 2018 humana no longer requires preauthorization for outpatient physical speech and occupational therapy ptstot services.
15 20413 1 4. Orthonet will evaluate the medical necessity of the service and request needed medical records. Each provider must be set up in the change healthcare system to receive era files. Determine if mailing or faxing appeal package i.
A provider can submit an enrollment form themselves or instruct their vendor to use our self service enrollment portal to link you to the payers. Complete and print appeal template cover letter contained in letters module. Orthonet will evaluate the medical necessity of the services and request needed medical records. Wellcare radiology prior authorization request.