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Friday, 3 August 2012

How to get Authorization from OrthoNet for Physical Therapy and Occupation therapy for Aetna members living in state of New York, New Jersey and Connecticut?



Aetna has delegated Medical Management and Claim responsibilities for in-network occupational and physical therapy services to OrthoNet for HMO, Golden Choice Plan and Golden Medicare Plan members. OrthoNet will process all requests for additional therapy services, other than the initial visit, and perform utilization review services.

We need to submit the therapy request form to OrthoNet and need to fill the below information. Its need to be fax #800-477-4310

Therapy Provider Information

  • Facility Name
  • Street Address
  • City
  • State
  • Zip
  • Telephone Number
  • Fax Number
  • OrthoNet Provider ID Number
  • AETNA Provider ID Number
  • National Provider Identifier (NPI)
  • REFERRING Physician's AETNA ID Number

Patient Information

  • First Name
  • Last Name
  • Member ID Number
  • Date of Birth
  • Aetna Plan

Request Information

  • Service Type
  • Initial Evaluation Date
  • Diagnosis Code
  • If this request for post or pre-operative therapy visits
  • Requested #of Visits

You will find this Authorization template in the below link

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