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Th this request 2. Please ensure that this form is a DIRECT COPY from the MASTER 3. Please PRINT, in black ink, one character per box for ALL requested information 4. Please completely fill in each circle that represents the corresponding NUMBER entry 5. For assistance in completing this form, please call OrthoNet Provider Services at (800) 448-6152 For Internal Office Use Only A S P THERAPY PROVIDER INFORMATION Facility Name Or Provider First Name Provider Last Name Street Address Cit.

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Should you need to, you may call OrthoNet's Provider Service Department at 1-800-401-0062 to ascertain the status of a member's authorization request. Our authorizations all bear expiration dates.

What is OrthoNet's role in the review process? OrthoNet will review selected musculoskeletal claims and compare the claim submitted to the services documented as rendered ing to the operative or office notes.

As used in this policy, terms such as "we" or "our" and "Company" refer to OrthoNet (an Optum company) and its current and future affiliated entities, including Optum parent company UnitedHealth Group.

OrthoNet maintains a number of provider networks in addition to working with health plan provider panels. If you are participating with OrthoNet and are changing your Tax ID#, please contact the Provider Contracting Department at 888-257-4353 before proceeding.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232