Select pain management services are administered 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 services and request needed medical records. An OrthoNet physician may contact the requesting physician to discuss the preauthorization request. Health care providers should submit requests with supporting clinical documentation at least four business days before the date of the service.
The terms prior authorization, precertification, preadmission, preauthorization and notification all are used to refer to the preauthorization process.
Exclusions from the preauthorization requirement include:
The easiest way to submit a preauthorization request for pain management services is by faxing the request directly to OrthoNet at 1-888-605-5345. Request forms are available on OrthoNet’s website. Fax the completed form and this supporting clinical information:
To initiate a preauthorization request for pain management via telephone, you may call OrthoNet at 1-888-605-5344 from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday.
As you move through the authorization 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 pain management. 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.
You may also initiate a preauthorization request for pain management services via the Web by logging in to the secure provider self-service area of Humana.com/providers (registration required) or the secure provider section of Availity.com (registration required; select markets only). Your request will be forwarded to OrthoNet for review, then OrthoNet will contact you to obtain supporting clinical information so that a determination of medical necessity can be made.
The following forms may be used for authorization requests in specific states:
Physicians and other clinicians in Texas may use this form to submit authorization requests for their Humana-covered patients. Instructions are available here (link opens in new window) . 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 authorization 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 1-888-605-5344 from 8:30 a.m. to 5:30 p.m. local time, Monday through Friday.
The OrthoNet website provides access to request forms, evaluation forms and other OrthoNet documents.