Preauthorization requests for select arthroscopy services are reviewed by OrthoNet, a utilization management company.
Humana requires preauthorization requests for the following services to be submitted to OrthoNet:
Preauthorization is required for the following:
OrthoNet will evaluate the medical necessity of the service and request needed medical records. An OrthoNet physician may contact the requesting physician to discuss the preauthorization request. Health care professionals should submit requests with supporting clinical documentation at least four business days before the date of the service.
OrthoNet does not review preauthorization requests for the following, as health care providers who participate in an independent practice association (IPA) or other risk network with delegated services need to refer to their IPA or risk network for guidance on processing preauthorization requests:
Other important information
The terms prior authorization, precertification, preadmission and preauthorization are all used to refer to the preauthorization process.
The easiest way to submit a preauthorization request for arthroscopy is by faxing the request directly to OrthoNet at 1-888-605-5345. Fax the request and the following supporting clinical information:
To initiate a preauthorization request for arthroscopy via telephone, you may call OrthoNet at 1-866-565-4733, from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday.As you move through the preauthorization process, you will be prompted to provide the information above, along with the name and identification number of the member and the physician.
Following OrthoNet’s review of the submitted information, you will be given an authorization number, or you will be asked for additional information if the request is incomplete or does not meet evidence-based criteria for arthroscopy. If OrthoNet requests medical records as a result of your preauthorization request, please return the information promptly to facilitate the timely processing of your request.
The following forms may be used for preauthorization requests in specific states:
Physicians and other clinicians in Texas may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are available here. Once complete, please fax it to OrthoNet at 1-888-605-5345. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.
Physicians and other clinicians in Indiana may use this form to submit preauthorization requests for their Humana-covered patients. Instructions are included on the form. Once complete, please fax it to OrthoNet at 1-888-605-5345. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.
Questions about this program may be directed to OrthoNet at 1-866-565-4733 from 8:30 a.m. to 5:30 p.m. Eastern time, Monday through Friday.
The OrthoNet website provides access to request forms, evaluation forms and other OrthoNet documents.