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) ….
Precertification
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.
Claim Submission
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) ….
Precertification
No precertification required
Claim Submission
Submit all claims to Aetna
Contact Information
Orthonet Inc.
Phone: 1-800-771-3205
Fax: 1-800-771-4310
Website: www.orthonet-online.com
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)