Spine Surgery & Pain Management UM Program Start Delayed

Date Issued: 9/1/2015

Please note: The start date for the EmblemHealth Spine Surgery and Pain Management therapies UM program managed by OrthoNet, LLC has been postponed to late fourth quarter 2015.

To help you care for your EmblemHealth patients with serious back problems, we have signed an agreement with OrthoNet, a leader in utilization management for musculoskeletal services such as spinal surgery and interventional pain management. This relationship expands access to experts in the field who can assist you in planning the best and most effective course of treatment for your patients.

Once this program begins, you will be required to contact OrthoNet directly to obtain prior approval for the spine surgery and pain management therapy procedures included here. In the coming months we will provide you with additional program information including access to the OrthoNet website and instructions on how to submit requests and follow up on your prior approval requests.

OrthoNet is a leading orthopedic specialty benefit management company in the United States. Their innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost-effective health care.

This program will apply to the procedures that are provided in any of the following settings:

  • Provider office (POS 11)
  • Inpatient hospital (POS 21)
  • Ambulatory surgery center (POS 24)
  • Outpatient hospital (POS 22)
Included Networks:
Enhanced Care Prime Network  
Premium Network Medicare Essential Network
Prime Network* Associated Dual Assurance Network
Select Care Network EmblemHealth Dual Assurance Network
NY Metro Network VIP Prime Network
Program Exclusions:
  • Group Health Incorporated (EmblemHealth EPO/PPO and GHI EPO/PPO)
  • HIP members assigned to a Montefiore, St Barnabas or Health Care Partners PCP (Members can be identified by the Montefiore or HCP logos on the ID card)
  • Vytra Network

*includes the GHI HMO Network.

In the coming months we will provide you with additional program information including how to access the OrthoNet website and the process for submitting a request for Prior Approval.