Saturday, 27 October 2012

How to get Authorization from OrthoNet for Physical Therapy and Occupation therapy for Uniformed Services Family Health Plan?

OrthoNet is Uniformed Family Service Health Plan's network manager for all outpatient physical and occupational therapy services in New York and New Jersey. OrthoNet has also been delegated as claims administrator for the in-network claims covered by this arrangement.

We need to submit the therapy request form to OrthoNet and need to fill the below information. Its need to be fax #1-800-874-0452

Therapy Provider Information

  • Facility Name
  • Street Address
  • City
  • State
  • Zip
  • Telephone Number
  • Return Fax Number
  • OrthoNet Provider ID Number
Patient Information
  • First Name
  • Last Name
  • Patient ID Number
  • Date of Birth
Request Information
  • Service Type
  • Initial Evaluation Date
  • Diagnosis Code
  • Requested # of Visits
You will find this Authorization template in this link


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