Health Net (Northeast)

Health Net of the Northeast has delegated to OrthoNet medical management and claims responsibilities for physical and occupational therapy services for its members in the New York, New Jersey, and Connecticut regions.

See Frequently Asked Questions Connecticut

See Frequently Asked Questions New Jersey

See Frequently Asked Questions New York

Forms

Click the link to open the form in a new browser window, then use your browser's Print button to print it. To download the form for later printing, right-click the link and choose "Save target as..." from the popup menu. Then use the file dialog to navigate to a folder on your harddrive where you wish to save the file.

Get Adobe ReaderAll forms are PDF files. You'll need Adobe® Reader® to view and print them. Adobe Reader is available from Adobe for free.

Therapy Request Form NJ Claim Appeal Application Form  
PT/OT Initial Evaluation Report  
PT/OT Initial Evaluation Report For Vestibular Dysfunction  
Functional Progress Chart  

Authorization
and
Claims Status

Using our secure site, you may check an authorization or the current status of a claim (24-hour access).

Please have your authorization/claim number ready.

Contact

Medical Management
800-413-8695
Fax: 800-450-4189

Provider Services
800-413-8695

Health Plan Web Site

www.healthnet.com