New Rochelle Radiology TIN: Precertification Requirements
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1 New Rochelle Radiology TIN: Precertification Requirements 175 Memorial Highway NPI: Lockwood Avenue NPI: PET/ Aetna through CareCore Aetna Golden icare through CareCore Affinity Health Plan 11 digit ID Affinity Health Plan Affordable Care/ObamaCare ID begins with H Precert required for all imaging studies Ray Fluoroscopy Affinity Health Plan icare ID has an M in the middle Anthem Blue Cross Blue Shield Through AIM Beech Street PPO BlueCard SWSCHP Prefix TUR Through Coordinated Health/Care
2 PET/ Blue Cross/Blue Shield Most Plans Require Precert Through AIM Blue Cross/Blue Shield Senior Plan/ VOF plans Through AIM Blue Cross/Blue Shield Federal Plan ID begins with R No Precert required CenterLight Healthcare Formerly CCM Christian Brothers CIGNA HMO Through Solutions Cigna.medsolutionsonlin e.com CIGNA PPO Precert required for some plans. If not indicated on back of card, you must check Connecticare Through NIA When more frequent than 1 in 23 mos Elderplan- Only 175 office par Through Care To Care EmblemHealth EPO, PPO,
3 PET/ Empire Government Plan United HealthCare Benefits Management Fidelis Care Precert req for Hysterosalpingograms Inj CPT when not being done for cancer not req when cancer diagnosis (140.x 239.x) First Health Precert Varies from plan to plan GHI through CareCore GHI HMO through CareCore HIP through CareCore Req. referral for all radiology studies that do not require precert - except screening mammo Referral not required for: Access 1 and II, EPO, PPO, VIP HIP Montefiore IPA Through the IPA Referral not required Needed for MRI Only. (Not ) Health First - 3
4 PET/ Health Republic Through NIA eff 8/1/15 Health Republic of NJ x Hudson Health Plan eff 7/1/ Humana/ChoiceCare Comm and Mcare plans Updated 9/14/13 RadConsult Local 1199 Through Care To Care Must Have Patient s SS#! Cardiology Eff 11/1/12 Locals Varies from plan to plan. Contact number on card. MVP all plans 4/1/12 Through CareCore MagnaCare precertification varies from plan to plan Must Have Patient s SS# and the phone number of the local! MagnaCare/Pavers and Builders
5 PET/ icaid-through RadConsult or fax MultiPlan precertification varies from plan to plan Oxford PHCS varies from plan to plan Pavers and Builders/ MagnaCare POMCO varies from plan to plan. To check requirements Authorization Precert strongly advised SWSCHP BlueCard TUR Through Coordinated Health/Care Touchstone Through Care to Care Touchstone Through Touchstone Tricare/US Family Health Pre-certification varies based on C.P.T. code referral required for some studies. No precert req 70,000 series Diagnostic Mammo 5
6 PET/ United Healthcare Pre-notification through UHC eff 8/13/12 To determine if required: United Healthcare Community Plans Pre-certification through UHC United Healthcare Navigate Through UHC WellCare Effective 3/2/09 6
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