Re: Orthonet and claims submission

[Guest guest]

Jim,

Orthonet is simply a mediator for certification/authorization of visits for

PT. Meaning they approve the visits, get the claims forwarded over to them

by the insurance company (oxford, BCBS, cigna etc) and they then send you a

check for the service. It sound like you are not a part of the Cigna HMO which

is run through Orthonet. In either case you are submitting the claims for

processing to the insurance company and then if they send it to orthonet.

What is confusing to you, I think, is that cigna's PPO and other products

don't use Orthonet and the HMO does. With oxford & BCBS all the claims are run

through orthonet, by the provider.

Vinod Somareddy, DPT

In a message dated 2/27/2008 4:49:03 P.M. Eastern Standard Time,

laurieeliteptkc@... writes:

Hi Jim,

I'm not familiar with Orthonet and how they operate. Typically you should

submit claims to the address on the patient's insurance card.

Laurie

Office Manager

Elite Sports Medicine & Physical Therapy

Kansas City, MO

Trakis <_jetrak86@..._ (mailto:jetrak86@...) > wrote:

My billing manager and I are relatively new to the game of running billing

and running a practice, respectively. We have been getting the run around

from orthonet. We understand that Orthonet is subcontracted by various

insurance companies to process claims, set fees, etc. We are confused with

regard to who to submit the claims to in this instance...A patient comes in

with Cigna but does not require pre-certification and therefore there is no

contact with Orthonet. Does the electronic claim get processed with the

Cigna or orthonet payor ID? Thanks in advance for your help.

Jim Trakis, DPT

Fortius Physical Therapy

850 7th Avenue

Suite 406

NY, NY 10019

ph:

fax:

_jetrak86@..._ (mailto:jetrak86@...)

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[Guest guest]

Hi Jim,

I'm not familiar with Orthonet and how they operate. Typically you should

submit claims to the address on the patient's insurance card.

Laurie

Office Manager

Elite Sports Medicine & Physical Therapy

Kansas City, MO

Trakis wrote:

My billing manager and I are relatively new to the game of running

billing

and running a practice, respectively. We have been getting the run around

from orthonet. We understand that Orthonet is subcontracted by various

insurance companies to process claims, set fees, etc. We are confused with

regard to who to submit the claims to in this instance...A patient comes in

with Cigna but does not require pre-certification and therefore there is no

contact with Orthonet. Does the electronic claim get processed with the

Cigna or orthonet payor ID? Thanks in advance for your help.

Jim Trakis, DPT

Fortius Physical Therapy

850 7th Avenue

Suite 406

NY, NY 10019

ph:

fax:

jetrak86@...

---------------------------------

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[Guest guest]

Hi Jim,

4 insurance co that falls under orthonet, healthnet, aetna,cigna and oxford,

you will need to call and verify the coverage with the reg. ins. they will tell

you that you will need auth through orthonet. you need to be par with orthonet.

call this is aetna orthonet telephone number. all hmo policies will

go through them. aetna pays 44,cigna 55, oxford 50 and healthnet 52 no matter

what. maybe nyc is a lil more but not much.

diana

jersey central physical therapy

Laurie wrote: Hi

Jim,

I'm not familiar with Orthonet and how they operate. Typically you should

submit claims to the address on the patient's insurance card.

Laurie

Office Manager

Elite Sports Medicine & Physical Therapy

Kansas City, MO

Trakis wrote:

My billing manager and I are relatively new to the game of running

billing

and running a practice, respectively. We have been getting the run around

from orthonet. We understand that Orthonet is subcontracted by various

insurance companies to process claims, set fees, etc. We are confused with

regard to who to submit the claims to in this instance...A patient comes in

with Cigna but does not require pre-certification and therefore there is no

contact with Orthonet. Does the electronic claim get processed with the

Cigna or orthonet payor ID? Thanks in advance for your help.

Jim Trakis, DPT

Fortius Physical Therapy

850 7th Avenue

Suite 406

NY, NY 10019

ph:

fax:

jetrak86@...

---------------------------------

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