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
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:
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.
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.
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 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.