News & Updates
Starting November 1, 2015*, OrthoNet will handle the management of both in-network and out-of-network outpatient physical therapy and occupational therapy services. OrthoNet is a musculoskeletal management company that has ties to leading therapists in Anthem’s service areas. It also has created many best practices followed throughout the industry.
Here’s what this new relationship means to your clients. This program consists of a utilization management program.
The Utilization Management program will affect your clients who have the following health plans:
Local fully insured Large Group, Small Group, and Individual products for both public and private exchange business including:
Here’s what remains the same
The first time members get an initial evaluation from a physical or occupational therapy provider as an outpatient, they do not need to get prior authorization (prior authorization is also referred to as prior approval or precertification). A member’s current physical and occupational therapy benefit will not change as a result of this new arrangement, as long as the therapy is medically necessary. Getting prior authorization will not affect the member’s access to the care he or she needs.
Here’s what changes
Starting November 1, 2015*, after the initial evaluation as an outpatient, members will be required to obtain prior authorization from OrthoNet for all physical and occupational therapy services for the services to be covered.
How Anthem is communicating this
Anthem is sending communications to employers, members and network providers telling them about the changes that go into effect November 1, 2015*.
Anthem and OrthoNet are committed to working together to provide their members with access to the services they need.
If you have any questions, please contact a member of your b&p Sales Team - 888.722.3373.
*The implementation date is subject to the approval of the Department of Managed Health Care.