Physical and Occupational Therapy Services: Precertification and Claims Processing
Aetna has delegated to a third party vendor responsibility for Pre-certification and/or Claims Processing of physical and occupational therapy services, under our HMO and Medicare (except for Medicare Fee For Service) products
Please Note: Except as otherwise indicated, whether the vendor is responsible for pre-cert, and whether the claim should be sent to the vendor or to Aetna, is determined by the location of the Primary Care Physician’s (PCP’s) office; if the Member does not have a PCP, it is determined by the Member’s residence.
PCP’s office, or if there is no PCP the Member’s residence, located in a county in Northern New Jersey (Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean Passaic, Somerset, Sussex, Union, or Warren) ….
Contact OrthoNet Inc. for precertification HMO and Medicare
Note: Some Plan Sponsors have elected not to participate (PDF, 25 KB) in Orthonet’s precertification program.
Submit to Aetna:
Submit to Orthonet:
PCP’s office, or if there is no PCP the Member’s residence, located in a county in Southern New Jersey (Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, or Salem) ….
No precertification required
Submit all claims to Aetna
New Jersey Claim Form - “Health Care Application to Appeal a Claims Determination”
Aetna: http://www.aetna.com/provider/data/NJ_prov_appeal_proc.pdf (PDF, 21 KB)