Out Patient

Outpatient therapy

Occupational, physical and speech therapy

Preauthorization requests for outpatient therapy services are reviewed by OrthoNet, a musculoskeletal disease management company that provides a broad range of orthopedic administrative and medical management services. OrthoNet is Humana’s network manager for designated outpatient occupational, physical and speech therapy services and conducts peer-to-peer reviews of physicians’ preauthorization requests.

Preauthorization and notification requirements

The terms prior authorization, precertification, preadmission and preauthorization all are used to refer to the preauthorization process. Humana requires preauthorization for outpatient therapy services for most commercial and Medicare Advantage (MA) members. Preauthorization requirements for administrative-services-only groups and Medicaid members vary; please call Humana at the number on the back of the member’s identification card to determine whether preauthorization is required.

For Medicare Advantage (MA) private fee-for-service (PFFS) plans, notification is requested, but it is not required.

OrthoNet does not review preauthorization requests from health care providers who participate in an independent practice association (IPA) or other risk network with delegated services. These health care providers need to refer to their IPA or risk network for guidance on processing preauthorization requests.

Other important information

  • For Humana commercial individual members, Illinois Humana Integrated Care Program members and MA HMO members in Alabama, California, Florida, Georgia, Louisiana, Mississippi, Nevada, North Carolina, South Carolina and Tennessee, preauthorization requests may be submitted using Humana's Interactive Voice Response system (IVR) at 1-800-523-0023. If needed, representatives are available from 8 a.m. to 8 p.m. Eastern time, Monday through Friday.
  • For Puerto Rico commercial members, submit preauthorization requests by telephone at 1-800-611-1474, or by fax to 1-800-658-9457.
  • For Puerto Rico MA members, submit preauthorization requests by telephone at 1-866-488-5995 or 1-866-773-5959, or by fax to 1-800-594-5309.
  • For MA Private Fee-for-Service (PFFS) members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
  • Preauthorization is not required for services provided by nonparticipating health care providers for MA PPO members. Notification is requested, but not required, as this helps coordinate care for our members.

Submitting preauthorization requests

Humana requires that occupational, physical and speech therapy treatment plans ordered for a Humana-insured patient be faxed to OrthoNet at 1-800-863-4061. MA PFFS notifications also should be submitted in this manner.

The following forms may be used for preauthorization requests in specific states:

Texas preauthorization request form

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 1-800-863-4061. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Indiana preauthorization request 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 1-800-863-4061. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.

Additional resources

Humana/OrthoNet therapy program for Humana members and related forms

Learn more about this program and the patient information required when requesting preauthorization. This link also provides access to therapy request forms, evaluation forms and other OrthoNet documents.

Questions

Questions about this program may be directed to OrthoNet’s provider services department at 1-800-862-4006. Representatives are available to assist callers between 8 a.m. and 8 p.m. Eastern time, Monday through Friday.