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| AETNA - HMO/PPO Plans |
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Pre-Certification requirement through Medsolutions for CT, MRI, MRA, Nuclear Medicine, PET Scan, and HSG for infertility |
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1-888-693-3211 |
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AETNA - Managed Care MCII/PPO or MC/PPO |
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Check for Pre-Certification requirement |
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1-888-693-3211 |
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ANTHEM - PPO/POS BC/BS of Virginia |
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Call for Pre-Auth For MRI, MRA, DEXA, and Invasive study |
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1-800-242-7277 |
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ANTHEM - Healthkeepers |
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HSG, Invasive Study and Nuclear Medicine Exam. Auth for MRI, MRA, CT and PET |
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1-800-533-1120 |
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CAREFIRST- BC/BS of Maryland |
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Signed referral slip |
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CIGNA - HMO / PPO / POS Plans |
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For MRI, MRA & CT, call Med- Solutions for Pre-Auth |
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1-888-693-3211 www.medsolutions.com |
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COMMERCIAL
PLANS (ALL) |
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Signed referral slip |
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COVENTRY
HEALTH & LIFE (Formerly
"Old Quality Choice") |
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Department of Labor |
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All exams need Pre-Auth from DOL. Must provide CPT Diagnosis Codes, Date of Service, and Claim # (from employer). DOL takes 30-90 days to assign a Claim #. |
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1-866-335-8319 |
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FIRST HEALTH |
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Signed referral slip is needed. See ID card for preauthorization requirements |
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KAISER (MEDICAL IMAGING NETWORK) |
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Must have referral for
MRI, MRA, Nuclear Medicine, Positron Emission Tomography, and interventional studies. Referrals for Mammograms for under 39 yrs and over 70 yrs of age. |
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1-800-810-4766 |
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MAMSI LIFE & HEALTH |
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Signed referral slip: Pre-Auth is required for HSG W/ infertility diagnosis |
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MDIPA / OPTIMUM CHOICE HMO |
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Referral for MRI, MRA, CT's, DEXA, Nuclear Medicine. Certain procedures may require preauthorization. Preauthorization is needed for HSG with diagnosis of infertility. Verify requirements with your insurance company. |
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1-800-738-1837 |
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MEDICARE - TRAILBLAZER PART-B SERVICES ONLY |
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Signed referral slip |
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NALC |
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No Authorization Needed |
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NCPPO |
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Signed referral slip |
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One Net, formallyALLIANCE – PPO |
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Signed referral slip |
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One Net, formallyALLIANCE – GEHA |
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Call Med Solutions for Pre-Auth for MRI & CT |
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1-888-693-3211 |
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| OPTIMUM CHOICE PREFERRED |
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Referral for MRI, MRA, CT & DEXA. Pre-Authorization for HSG with diagnosis of Infertility. Need Out-of-Plan Waiver signed. |
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| PHCS |
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Must check on all plans for pre-certification requirements |
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| PRINCIPAL HEALTH PLAN / HMO |
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Must have referral for all imaging exams |
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| TRICARE / HEALTH NET (Formerly "CHAMPUS") |
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Signed referral slip is needed.
Pre-operation Chest Xray and Routine Obstetrical
sonograms are not covered. |
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| TRICARE FOR LIFE / HEALTH NET |
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Signed referral slip is needed
Pre-operation Chest Xray and Routine Obstetrical
sonograms are not covered. |
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UNITED HEALTHCARE
- MID-ATLANTIC / PPP / POS |
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Notifications needed for MRI, MRA, CT's, Positron Emission Tomography, and all Nuclear Medicine exams , Pre-authorization for Positron Emission Tomography, MRI, MRA's. Only 1 (one) Routine Obstetrical Sonogram
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1-866-889-8054
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WORKERS COMPENSATION
PLANS |
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Call
for Pre-Certification on all exams |
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Need Employer
and Policy Information |
