RE: Credentialed with Medicare, not with Humana

[Guest guest]

Here are some tips as far as submitting goes. In our area Human uses Orthonet as

a management service for rehab services. You need to get the Humana Medicare

plan fax form to submit to Orthonet prior to the second visit. We tend to do it

day of eval if possible or next day. You will get the eval visit granted

automatically and then they will only approve additional visits after that fax

date. They will then tell you how many visits are approved- Usually 6 for

non-operative and 8 for post-op. So if you submit the form at visit 4- you will

only be approved for visits after that date. THEY DO NOT BACK DATE. If you need

more visits you need to go thru the process of asking for more by showing

justification and improvement in patient status. They require a pain scale,

strength test, ROM. Without those you can expect not to get approval. That being

said any eval should have that and more to begin with. Any claims that are in

question need to go thru the Humana appeals process.

Carl D Grota, PT

Physical Therapist

Ministry Door County Medical Center

Rehab Services

1300 Egg Harbor Rd Ste 108

Sturgeon Bay, WI 54235

PH

Fax

RE: Credentialed with Medicare, not with Humana

You would have to be contracted with Humana. Humana Medicare is affiliated with

Humana insurance, not Medicare. Humana has offered people a Medicare plan to

help patients with their health care, ie. Prescriptions. This is true with all

of the insurance companies that offer a Medicare Plan, like Lovelace Medicare

and Cigna Medicare. Make sure your front office knows the difference between the

Medicare insurance plans and the Medicare supplements. It will state this on the

patients card.

I hope this helps.

Crystal Gallegos

C & M Business Professionals,LLC

or " Innovations to maximize

profitability " www.cmbizpro.net