Effective November 1, 2015, Anthem Blue Cross and Blue Shield (Anthem) will implement a physical therapy (PT) and occupational therapy (OT) benefit management program for outpatient and office services. In order to help us effectively administer this program, we have contracted with an external vendor, OrthoNet LLC, to work with us on this initiative. The program will be implemented in Indiana, Kentucky, Missouri, Ohio and Wisconsin.
OrthoNet will receive all requests for office and outpatient physical and occupational therapy services and review those requests for medical necessity. Beginning October 19, 2015, providers should contact OrthoNet for prior authorization requests. Providers will be notified by OrthoNet of the determination via mail and fax.
Providers can contact the Anthem Provider Services phone number on the back of the member’s ID card for benefit information. They will be informed whether the OrthoNet program applies. OrthoNet will also have a list of the in-scope membership and will not provide precertification for members who are out of scope. If providers use ICR to precertify an outpatient PT/OT service, ICR will produce a message referring the provider to OrthoNet.
Beginning October 19, 2015 providers can request authorizations in two ways.
1. By fax: Providers may complete the OrthoNet Fax Request Form (containing the member’s demographics and insurance information) and the PT/OT Initial Report Form or Functional Progress Chart (containing the member’s supporting clinical information). These documents are available on the OrthoNet website, www.orthonet-online.com. Providers may also use their own forms or clinical notes that will supply the same information. These documents need to be faxed to the OrthoNet Medical Management Automated Fax Request line, 844-216-1599.
. By Phone: Providers may contact the OrthoNet call center at 844-282-6994 in order to start the authorization request by supplying the member’s information. The provider may then complete the PT/OT Initial Report Form or Functional Progress Chart (containing the member’s supporting clinical information), available on the OrthoNet website, www.orthonet-online.com. Providers may also use their own forms or clinical notes that will supply the same information. The provider will then complete the request by faxing these documents to the OrthoNet Medical Management Automated Fax Request line, 844-216-1599.
Note: OrthoNet is currently working on capability for providers to submit authorization requests and check authorization status via website. These automated capabilities will be available in 2016 at www.orthonet-online.com.