Out Patient

Outpatient therapy

Occupational, physical and speech therapy

Preauthorization for outpatient therapy services is administered 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, preauthorization and notification are all 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 to determine whether preauthorization is required.

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

Exclusions from this requirement include the following members and providers: 

  • HumanaOne® members
  • Commercial and MA health maintenance organization (HMO) members assigned to a risk-based or delegated independent physician association (IPA) or physician hospital organization (PHO)
  • MA HMO members in Alabama, California, Florida, Georgia, Louisiana, Mississippi, Nevada, North Carolina, South Carolina and Tennessee
  • Atlanta MA HMO members
  • Kentucky Teachers' Retirement System (KTRS) members enrolled in an MA plan
  • Puerto Rico 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 should also be submitted in this manner.

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 or providing notification. 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. EST, Monday through Friday.