Welcome to the OrthoNet Spine, Pain, and Joint Provider Portal.
As we transition from OrthoNet to Optum's Spine, Pain, and Joint program, you may see changes in the original OrthoNet Portal. All authorizations submitted on behalf of EmblemHealth and Healthfirst will continue to be processed using the OrthoNet provider portal until further notice. Providers will see a notification from their health plan at least 30 days in advance of the migration from the old to new portal.
For more information, please review the appropriate section below.
Submit Online
If you are logging into the portal to submit a new authorization or check status: Click Here
If this is your first time visiting the OrthoNet Portal, and you are a new user: Click Here
For Step-by-Step Instructions: Click Here
Health Plan Contracts
EmblemHealth
EmblemHealth has delegated utilization management for select spine surgery and interventional pain management therapy procedures to OrthoNet. The Program requires that the treating clinician obtain prior approval for spine surgery and interventional pain management procedures defined by a list of CPT/ICD codes. For a full list of spine surgery and interventional pain management therapy codes that require prior approval please visit emblemhealth.com. As with all utilization management programs, this Program will determine if the proposed service meets the definition of medical necessity under the member's benefit plan.
Healthfirst
Healthfirst has delegated the utilization management of spine surgery, as well as interventional pain management procedures (not including trigger point injections) in all outpatient settings to OrthoNet. To review authorization requirements, go to https://hfproviders.org.
Services for members covered by Healthfirst's programs require prior authorization through OrthoNet. Healthfirst will continue to provide all other related services for these procedures such as claim payment, patient case management, member and provider services.