AARP

• Usually secondary to Medicare
• No precertification required

ACCESS

• There are several medical assistance plans. The most common Medicaid plan is ACCESS (also known as traditional - Medical Assistance(Yellow ACCESS card)
• As of 9/1/08 CT'S and CTA'S will now require authorization providers must call NIA 800-424-4213 from 8am-8pm
• Authorization numbers for CT'S or CTA'S will begin with the number 0
•  NO authorizations needed secondary to Medicare
• Provider number 0011766440001-needed when you need to call for authorization for PET, CT'S, AND CTA'S Access does not use tax ID#
• Offices need to call 800.558.4477 for authorizaion
• Access card can be used with another insurance card
• Ask if patient has an additional card

AETNA BETTER HEALTH

• PA Medicaid product so follows medical assistance guidelines
• Eligibility changes monthly so must check by going to website aetnabetterhealth.com or http://promise.dpw.state.pa.us/
• has own identity (not a plan of Aetna)...different website, phone number and mailing address
• As of Jan 1, 2011 only PET SCAN'S need authorizations.  CT'S and CTA'S not longer need auth.
• Authorizations will have a 48 hour turnaround time.
• Authorizations will be good for 60 days and are code specific.
•  

Advantra

• This is through Health America
• Providers will need to call 800-755-1135 between 8:30am-5pm est

Aetna

• Provider number is: HMO- 99098 or Traditional non-HMO(PPO)- 4450981
• https://navinet.navimedix.com 
•  PET ONLY:  for "W" plans- providers must call 888-632-3862 to get benefits first then ask if the plan requires precert! Call MEDSOLUTIONS for precert@ 888-693-3211
• Referrals from PCP are required for some plans-see column 2 
• There are 2 types of Aetna: HMO and Traditional. Traditional plans the ID will begin with a "W". The HMO plans begin with a mixture of letters and numbers. Some HMO plans are capitated (which means patients insurance has already paid for them to go to another facility). We cannot accept this plan without a referral from the patient's PCP.
• If a pt has Aetna HMO and they are capitated to LEHIGH VALLEY HEALTH NETWORKS, they do not need a referrel because they are capitated to us.
• Medicare Replacement cards start with "ME" then numbers. See grid for referral information. Some are HMOs.
• NAP is not a plan, ask for more information. NAP is for hospital, not outpatient.
• To verify that a plan does not require an auth you can go to www.aetna.com then click on "health care professionals", then click "policies and guidelines", then click "precertification". Enter the CPT code for the study you are looking at and enter.

AliCare

• Medicare Supplement

AmeriHealth via Independence Blue Cross

• Provider ID: 0385099000
• https://navinet.navimedix.com
• NOT AmeriHealth Mercy or AmeriHealth TPA
• For precertification for CTs call AIM 800.859.5288
• Precertifications are not IV Contrast related
• AS OF 1/1/09 AMERIHEALTH 65 PLAN IS EXCLUDED. Patients should've chosen a new Medicare plan.

AmeriHealth Administrators TPA via Valley Preferred

• This is now Independence Administrators

AmeriHealth Mercy Health Plan

 

• Provider ID: 47798
• NOT AmeriHealth or AmeriHealth Administrators TPA
• AS of 10/1/11 precertification will be thru Medsolutions by calling 800-572-1981
• Online precerting is now available
• Precert numbers are  IV Contrast related so providers need to specify correct CPT code when precerting
• Please book out 4-5 days after office will be starting precert. If needed sooner than that pt is to sign waiver.

AmeriHealth of New Jersey

• https://navinet.navimedix.com
• via Independence Blue Cross
• Offer our Tax Id number if office asks for Provider number
• Can be a plan that is part of AmeriHealth, Keystone, or Personal Choice plan-Ask office and indicate which 
• Precerts through AmeriHealth call AIM 800.859.5288
• Precerts through Keystone or Personal Choice call 800.227.3116, Option 3
• Check grid for referral and precert requirements.

American Medical Security via Valley Preferred

• Precertification requirements  for CT, CTA, and PET vary per patient's plan
• Precertification call: 1.800.232.5432, ext. 11510

American Progressive

Provider ID: American Progressive
•   This is a Medicare replacement plan- this plan will REPLACE medicare.
• No precertification is needed-follows Medicare guidelines

Anthem www.anthem.com (BCBS)

• This insurance is plan related for CT
• Office must call # on back of card if scheduling a CT
• Ask office to check back of card for precertification requirements as a secondary insurance
• AIM phone # is 1-877-291-0360

Assurant Health/Fortis via Valley Preferred

• NOT Health AssurANCE
• John Alden Life Insurance Company

BC/BS ILLINOIS

Provider ID: BC/BS ILLINOIS
• Auth is not required for CT'S, CTA'S or PET scans

BC/BS RHODE ISLAND

Provider ID: BC/BS RHODE ISLAND
• Precerts go through Med Solutions by calling         1-888-693-3211. Auth's ARE contrast related so give office CPT codes.

BCBS Florida- Capital Blue Cross

• Offices are to call 1-888-376-6544 for precerts.
• The prefix for this insurance will be HHM.

BRAVO HEALTH

Provider ID: BRAVO HEALTH
• Medicare Supplement plan but it is an HMO with no out of network benefits
• LVDI is not in network and members can not come here for services
• Patients must utilize facilities in the area they live (ex:Pottstown, Willowgrove)

BUILDERS BENEFITS (VALLEY PREFERRED)

• This is thru Health America
• Needs AUTHORIZATION for Ct's Cta's and Pet scans

Beech Street Corporation (see Raytel Imaging)

• If a patient has insurance through Beechstreet their study should be scheduled through One Source Medical. Raytel Imaging was bought out by ONE SOURCE MEDICAL.
• Call 1-800-453-0574 and hit "0" for scheduling to get confirmation number.
• See Melissa Good when offices request this insurance!

Berkshire

• LVDI does not participate and cannot accept this plan at this time.

Blair Mill (ICHP)-via Valley Preferred

• "Valley Preferred" must be on the card in order for LVDI to be in par
• If we are in par; office must call number on back of card for precertification for CTs.

Blue Card PPO

• Blue Card PPO allows a member to use any BCBS network in the country, so LVDI is in par
• For precertification requirements call number on back of card.

Blue Choice (BCBS)

• Check back of card for website need more details on what kind of insurance
• Secondary to Medicare or Medicare Replacement nothing needed.

Blue Cross Blue Shield (BCBS)

• Can be out of state card
• Check back of card for website; the abbreviation for the state will be within the website and this is how to determine if it is out of state. If this is the case; call number on card to determine if precert is needed for CTs.
• No authorization is needed secondary to Medicare
• Use BCBS button for entire listing of BCBS plans.
• The following number can be called for any insurance card that has the word "blue" on it. This number will direct to the correct state if office cannot confirm website.

  BLUE CARD number:  1-800-676-2583  - Press option 5 and speak the 3 letter prefix of the card.

Blue Cross Blue Shield of Tennessee

• This out-of-state insurance is still plan related.
• To verify if precert is required contact MEDSolutions 1-888-693-3211 or precert online www.medsolutionsonline.com (no date of service is required).

BlueCross BlueShield Access Care (BCBS)

• Check front and back of card for website information

BlueCross of Northeastern PA www.bcnepa.com (BCBS)

• www.bcnepa.com
• NOT Capital Blue Cross or Highmark Blue Shield
• Do NOT ask for prefixes
• Ask office to check back of card for website
• If website is bcnepa.com: Precert is needed as of Nov 1, 2011 Note: If scheduling any other study except a CT; no need to be specific as no referrals are required with any study.
• Secondary to Medicare or Medicare Replacement nothing needed.

CHAMPVA different plan from TRICARE

• Call the number on back of card to inquire if precerts are needed
• Secondary to Medicare no authorization is required

Capital Blue Cross

• Provider number is: 02331500
•  If Capital Blue Cross (including YWK, YWV, and PFP) is a Secondary insurance,  NO AUTH needed.
• When scheduling CT's and CTA's ONLY PREFIXES  - YWK - YWV - PFP-(no county listing applies as of 3/1/10)  need authorization.  No other prefixes need auth at this time.
• ALL PREFIX'S NEED TO BE CHECKED FOR AUTHORIZATIONS FOR  PETS THRU CAPTIAL  BC 800-471-2242
• NIA AUTH'S ARE NOT IV CONTRAST SPECIFIC
• If office says PEBTF:  Must ask office if card is Capital Blue...
• Yes?  If yes, there are two types of PEBTF under Capital Blue Cross-MUST FIND OUT PREFIX-If PEB-STILL NO AUTH required for CT's only PFP PEBTF needs precert for CT if within county listings.  
• No?  If office says PEBTF and it is NOT Cap Blue, see PEBTF under letter P.
• YWW prefix is Sr Blue PPO and does not need authorizations for CT, CTA'S but does require auth for PET thru Capital BC NOT NIA
• For precertification call: NIA 888.203.1423 or ****precertification is now available on line through http://www.radmd.com/
• For the new BCBSFlorida prefix HHM auth's offices are to call 1-888-376-6544.

 

CareFirst BlueCross BlueShield (BCBS)

• Check card for website
• Secondary to Medicare or Medicare Replacement nothing needed.

Caremark

• Caremark is a discount drug plan not a medical plan
• Must ask for more detailed information

Carpenter's (BCBS)

Provider ID: Carpenter's (BCBS)
• This is a BC/BS plan.

Central PA Teamsters

Provider ID: Central PA Teamsters
• All cards must be checked for PRECERTIFICATION of CT & PET/CTs UNLESS all of the following words are on the card together: Central Teamsters PA; Devon; Health Assurance; Valley Preferred. This is the only card that we are sure does NOT require precertification. All others must be checked.

 

Choice Plus - via Valley Preferred

• Spectrum Administrators
• Plan for LVH employees
• Customer Service 610-969-0410
• CT VIRTUAL COLONOSCOPIES REQUIRE PRE-NOTIFICATION
• PET CT'S NOW REQUIRE A PRE-NOTIFICATION-providers should call 610-969-0410
• Calcium scoring is covered as screening

 

Cigna Healthcare via Valley Preferred

• No Paper referrals for ANY study - Only a RX(script) is necessary
• If there is a DIAMOND symbol on front of card; LVDI is out of network - cannot accept
• For pre-certifications of CT Scans call MEDSolutions 888.693.3211 OR precert on line www.medsolutionsonline.com
• Cigna that is secondary to MEDICARE does NOT need to be precerted as of July 1 2006
• Cigna secondary to all other insurances is still Plan Related.
• Be VERY specific about CPT code as they are contrast related

Colonial Healthcare - via Valley Preferred

• Usually this is secondary to Medicare

Connecticut General and Life (CIGNA)

Conseco

Provider ID: Conseco
• Medicare Supplement plan-no referrals or authorizations requried

Continental Life

Provider ID: Continental Life
• This is a Medicare Supplement plan-no referrals or authorizations are required

Core Health Insurance

• This is a Beech Street insurance.
• Must go through One Call Medical.
• Must have confirmation number from One Call Medical.

CoreSource

• CoreSource is an imaging authorization company (like NIA)
• Ask for more detailed information.

Coventry Healthcare Plan

• See Health America

Dental Care Alliance (employer) via Valley Preferred

• For precertification of CT scan call SYNERGY 800.796.7587

Devon Healthcare

• All cards must be checked for PRECERTIFICATION of CTs UNLESS-all of the following words are on the card together: Central Teamsters PA; Devon; Health Assurance; Valley Preferred. This is the only card that we are sure does NOT require precertification. All others must be checked.

EVERCARE

Provider ID: EVERCARE
•  This is a medicare replacement plan thru United HC
• Providers must call 888-866-8298 to see if authorization is required for CT'S , CTA'S and PETS

 

Empire BlueCross BlueShield www.empireblue.com (BCBS)

• Check ID card for website www.empire.com
• Call number on back of card for pre-cert information as these all vary and are plan related.
• Secondary to Medicare or Medicare Replacement nothing needed.

Excellus BlueCross BlueShield www.excellusbcbs.com (BCBS)

• Precertification is required for some CT scans for certain plan members.
   
• CT scans that need precerts: CT Sinus ; CT of Cervical , Thoracic, or Lumbar Spine; CT of Lower Extremity
• For precertification call  Excellus at 888.576.7783
• Contact the local BCBS plan on patient's ID card.
• Secondary to Medicare or Medicare Replacement nothing needed.

Federal Black Lung

Federal Employee Program (FEP) Blue Cross Blue Shield (BCBS)

• Service Benefit Plan
• ID usually starts with an "R"

Federated Insurance

• Precerts thru Encompass 866-411-2067

First Health

• LVDI IS NOT IN PAR- CANNOT ACCEPT AT THIS TIME
• There is a First Health Plan called First Health Plus which is a true Medicare Supplement. LVDI is NOT in par with this plan BUT WILL accept as it follows Medicare guidelines. This is the only First Health plan we will accept.

First Priority Health

• Provider ID 820848
• Update:  LVDI is now in par with First Priority effective 1/1/07.  However, this is only for our facilities located in Northampton and Lehigh Counties.
  • As of November 1, 2011 Providers will call NIA for prior authorization for CT'S, CTA'S and PET scans at 800-822-8757
• LVDI in Hamburg and KMI in Kutztown cannot accept this plan.
• For Precertification call 1-800-962-5353, however, form MUST also be faxed in to 570-200-6799. 
• Provider Line number for any questions to call is 1-800-822-8752
• Prefix for all First Priority Health Products is YZH BUT a PCP must be listed on the Ins card.  If  "no PCP selected" is on card, LVDI cannot perform the services, patient only has ER benefits.
• Secondary to Medicare nothing needed.

First Priority Life- BC/BS through Northeast PA

• This is a BCBS plan through Northeast PA
• As of November 1, 2011 providers will need to call NIA for authorizations for CT's CTA's and PET scans.  Providers will call 888-827-7117 for Traditional plans and 866-262-5635 for PPO plans
• Secondary to Medicare nothing needed

Fortis - (Assurant Health)

• Not Health Assurance
• John Alden Life Insurance Company

                     

   

 

 

Freedom Blue (Highmark Blue Shield)

• This is a Medicare Replacement through Highmark Blue Shield
• Requires precertification through NIA for Chest, Abdomen and Pelvis CT's, ALL CTA'S and ALL PETS
• Auth's thru NIA are not IV contrast specific

GHI

• LVDI is considered out of network with this insurance...if the patient accepts getting out of network benefits pt can schedule test here.
• GHI second to Medicare is ok as long as the plan follows medicare guidelines
• Call number on back of card to determine if the plan follows Medicare guidelines

Gateway Health Plan

Provider ID: 7563802
• Provider ID: 7563802
• For precertification call NIA 888.879.5922 (On Line Precertification not yet available)
• NIA authorizations are NOT IV Contrast specific
• Ultrasounds ordered by a OBGYN for a Transvaginal or Pelvis  DO NOT require an auth or referral!
• As of JAN 1, 2011 DEXA scans do NOT require a precert

Geisinger Health Plan- www.thehealthplan.com - via Valley Preferred

• Provider ID: 47172
• Some cards do not state Geisinger on the card. Check the card for a website www.thehealthplan.com
• Geisinger as a secondary insurance requires a precertification
• For precertification of CT scans call NIA 866.305.9729 or precert ON LINE through http://www.radmd.com/
• NIA authorizations are NOT IV Contrast specific

Golden Rule thru United Healthcare

• Offices must call 1-866-889-8054 for notification/certification for all PET Scans, CTA and CT scans
• Prenotifications are IV Contrast specific-the office must precert with or without IV Contrast specifically 

Great-West Healthcare via Valley Preferred

• For precertification of CT Scans call MEDSolutions 888.693.3211
• This is CPT code contrast related-offer offices the CPT code
• The insurance card does not need to specify VALLEY PREFERRED.

HOP - Health Options Program

Hamon Corporation (employer) via Valley Preferred

• For precertifcation of CT Scans call Healthcare Strategies 888.599.1515

Hartford Life Insurance

Health Net

• LVDI is NOT PAR and CANNOT ACCEPT at this time.

HealthAmerica, HealthAssurance, Lehigh Select (Tier 1) Coventry Healthcare Plans via Valley Preferred

• Be very specific about CPT codes as they are contrast related. Give offices CPT code
• Precerts are necessary if secondary to Medicare and any other insurance plans
• UPDATE:  As of 12/1/09 authorizations will be done thru NIA at 866-326-6303.  There will be a prompt for outpatient radiology services.

HealthGuard - NO longer available

Highmark Blue Shield www.highmark.com (BCBS)

• Provider ID: 563802
• https://navinet.navimedix.com
• Ask offices to be VERY specific about what BCBS plan. Ask the 3 letter prefix.
• Next ask what kind of CT study (Highmark requires precerts for CT of CHEST/ABDOMEN/and PELVIS in any combination together or separately)
• ALL CTA'S NEED PRECERT REGARDLESS OF BODY PARTS
• If Classic Blue - NOTHING is required(This plan is an exception)
• Highmark secondary to Medicare or other insurances DOES require precerts as listed below
• As of 8/1/07 the precertificaion number for NIA is  866.731.8080.  You will need to choose option #4. 
• Authorization thru NIA is NOT IV Contrast related

Horizon BlueShield/Horizon NJ+

• Horizon Blue Shield NJ plus- Benefits through local BlueCross BlueShield
• Horizon NJ Health- different from above plan- This is a state nationally funded program developed for New Jersey residents only.  LVDI should not see these plans.
• Horizon BC/BS secondary to Medicare does not need a precertificaton.
• Call 1-800-664-2583 for Horizon or 1-866-496-6200 for Care Core.

Humana

• There are 3 different Humana Plans. The Medicare plan is the only plan that we participate with only because there are no network requirements.
• The other 2 plans have requirements. Have office call number on card as LVDI is not in Par but patient can come here when certain criteria is met.
• There is now a Medicare Supplement plan which is secondary to Medicare...we do accept this card and it will not require any referrals or authorizations.

IBxpress (BCBS)

• Another BlueCross BlueShield Plan
• On the card the website will state www.ibxpress.com this is the way to distinguish from Highmark.
• Call the number on the back of the patients ID card for authorization

ICHP - Inter-County Health Plan/Blair Mill (employer) via Valley Preferred

• For precertification of CT Scans call Inter-County Hospitalization Plan 800.952.3404

Independence Administrator

Provider ID: Independence Administrator
• Formerly Amerihealth Administrators

Independence BlueCross

• https://navinet.navimedix.com/
• Provider number is: 0385099000
• If the card reads Independence BlueCross Highmark BlueShield it is a separate plan and plan related.
• If plan is capitated (some keystone plans); the insurance has already paid for the patient to go another facility.Needs an out of network referral.
• Referrals are obtained from PCP or ordering physician.
• For precertification of AmeriHealth plans call AIM 800.859.5288. -Precerts thru AIM are NOT IV Contrast specific. Press option #2 for provider THEN option #3 for precertification then option #1 which will take you to AIM.
• Keystone 65 Advantage HMO is no longer available as of 1/1/12. Pt's had to choose between Keystone 65 Select HMO and Keystone 65 Preferred HMO.
• LVDI and LVHN is NOT IN PAR with Keystone 65 Select HMO.
• Both Keystone 65 Select and Preferred have the same "YXI". If it is the Select plan the cards should have the word "Select" on it.

Insurance Administrator of America TPA

• Can accept as secondary to Medicare
• For precertifications call 800.283.2524

Intergroup Services Corporation/MultiPlan-see Raytel Imaging

• Scheduling Through Raytel. InterGroup PPO
• Call Raytel @ 800-453-0574 "Bill to Raytell needs to be notated in the insurance section when scheduling

John Alden Life Insurance Company - (Assurant health)

• Not Health Assurance

Keystone

• Provider #0385099000
• If a plan is capitated; the insurance plan has already paid for the patient to go to another facility; out of network referral required.
• Referrals made out to LVDI can be accessed and printed from Navinet
• For Precertification of CT Scans call AIM 800.227.3116 - Press option #3 then option #1.
•  Precerts thru AIM are NOT IV Contrast specific.
• KEYSTONE CENTRAL does not require authorization as a secondary to ANY insurance.
• Keystone 65 Advantage HMO is no longer available as of 1/1/12. Pt's had to choose between Keystone 65 Select HMO and Keystone 65 Preferred HMO.
• LVDI and LVHN is NOT IN PAR with Keystone 65 Select HMO.
• Both Keystone 65 Select and Preferred have the same "YXI". If it is the Select plan the cards should have the word "Select" on it.

Keystone Central (Capital Blue Cross product)

• Capital Blue Cross Plan-please see Capital Blue Cross when precerting thru NIA -Precerts thru NIA are NOT IV Contrast specific
• Prefix is YWV requires precert through NIA for CT, PET, and CTA
• For precertification cal NIA at 1-888-203-1423 or precert on line at WWW.RADMD.COM
• No referrals are necessary for any studies
• If this is secondary to any other insurance it does NOT require precertification.

 

Keystone Mercy Health Plan (Medicaid)

• Provider number is 30002384
• If a plan is capitated; the insurance plan has already paid for the patient to go to another facility; an out of network referral required.
• If patient is approved by Keystone Mercy to come to LVDI then precertification of CT Scans call 1-800-572-1981.
• Precertifications come from MedSolutions and are contrast related.
• If patient is approved to come to LVDI for studies other than CT..out of network referrals are required
• To verify eligibility and capitation call 1-800-521-6007.

Keystone Senior Blue (Capital Blue Cross)

• Capital Blue Cross Plan- This is a Medicare Replacement Plan
• Prefix YWW is a PPO plan-no precert needed
• Prefix YWK is an HMO plan and needs precert through NIA
• To precert call NIA at 1-888-203-1423 or precert on line at  WWW.RADMD.COM - Precerts thru NIA are  NOT IV Contrast specific

 

Knoll (employer) via Valley Preferred

• CT's of the Spine; Brain/Head; and Abdomen (or combinations) require a precertification
•  For precertification of CT Scans call Guided2Health 800.542.6355

Lehigh Select (Tier 1)

• See HealthAmerica

Lumenos (Air Products) - via Valley Preferred

• This is a plan for Air Products employees
• If the card states any other employer besides AIR PRODUCTS- for CT Scans...cards must be checked as they are plan related

 

MAGNACARE

• Must ask office what else is on card. Valley Preferred, PHCS, Multiplan, Beechstreet
• If nothing else on the card LVDI is considered out of network.

MED Link

• LVDI does not accept as primary insurance plan

MEDICARE

Provider ID: 563802

MEGA LIFE

Provider ID: MEGA LIFE

THRU DEVON HEALTHCARE 

• IF VALLEY PREFERRED is not located on the card LVDI is considered out of network.
• Plan related-provider must call plan

MedPLUS (Unison)

Provider ID: 82693
• Unison no longer exists. See UHC.

Medicaid also known as Medical Assistance

 

•  There are several medical assistance plans. See list below. The most common Medicaid plan is ACCESS (also known as traditional MedAssitance (Yellow Access Card)
• No authorizations secondary to Medicare
• Access card can be used with another insurance card- ASK IF PATIENT HAS AN ADDITIONAL CARD
• See "A" for Access for provider number

Medicare Replacement Plans

• Medicare Replacement plans take the place of Medicare.  Patients and/or Offices may still say Medicare and the replacement plan.  However, Medicare really no longer exists.
• Most of these plans do require precertification for  CTs however see grid  for detailed information as some do not.
• As of Jan 1, 2012 Keystone 65 Advantage HMO no longer exists. Pt's had to choose between Keystone 65 Select HMO and Keystone 65 Preferred HMO.
• LVDI and LVHN is NOT IN PAR with Keystone 65 Select HMO.
• Both the Keystone 65 Select and Preferred have a "YXI" prefix ask offices if the word "Select" is on the card.

Medicare Supplement Plans

MultiPlan

•  Call the number on the back of the patients ID card for precert if needed

Mutual of Omaha

•  Only accept this insurance as secondary to Medicare,  LVDI does not accept this insurance as primary as it would go through PHCS and we are not in par.

New Jersey Carpenter's Fund (employer) - via Valley Preferred

One Call Medical

• This was Raytel. It works the same way.
• One Source will call us to schedule.
• We should be given a confirmation number.
• Have patient sign Radiology Release Form.
• Offices can call 1-800-872-2875 and ask for scheduling department.

Oxford Health Plans - via Valley Preferred

• Provider ID: A3479868
• LVDI contracts all Oxford insurances through United Health Care or Valley Preferred so you may see a UH or VP symbol on the card but it is still an Oxford plan. As long as the word OXFORD is on the card, follow the guidelines for Oxford.  See O on grid.
• For precertification of CT Scans call Oxford 800.666.1353 directly. MUST inform offices that precertifications do go through CareCore. Please provide offices with correct prompts.
• USE THESE PROMPTS: Press #2; #1; #3;  then #1 - DO press #3 for radiology(CareCore)
• Oxford secondary to any other insurance MUST be precertified ...2ND to MEDICARE does not need precert!
• Must also give offices the CPT codes as they are contrast related authorizations.
• These authorizations usually begin with "A"

PATHS

This is for HOSPITAL ONLY!

LVDI does not take this insurance.

PEBTF

• If patient or office states PEBTF; ask if it is Capital Blue Cross.  If Capital Blue-see "C" for Capital Blue Cross. 
• If it is not Capital Blue Cross, it is usually second to Medicare and does not require an auth.

PHCS

• LVDI does NOT accept as primary insurance
• If card has any other insurance listed IE: MULTIPLAN, BEECHSTREET OR VALLEY PREFERRED we will take as primary and bill one of these insurances.
• As a secondary to Medicare - call # on back of card to ensure policy follows Medicare guidelines. We can accept if NOTHING is required. If it does NOT follow Medicare guidelines we cannot accept this card

PPHN

• LVDI does not accept as primary insurance. As a secondary to Medicare - call # on back of card to ensure policy follows Medicare guidelines. We can accept if NOTHING is required. If it does NOT follow Medicare guidelines we cannot accept this card.

Pacificare - via Valley Preferred

• LVDI is in par
• Check back of card for website/phone number

Palmetto GBA (Railroad Medicare)

Personal Choice

• via Independence Blue Cross
• For Precertification of CT Scans call AIM 800.227.3116 -  Press option #3 for the Health Resource Center then option #1 for CT'S, CTA'S or PET'S
• Precerts thru AIM are NOT IV Contrast specific.

REGENTS (BC/BS)

• Must check for precert with phone number on the back of the card.

Raytel Imaging Network/One Source Medical

• Raytel Imaging was bought out by One Source Medical.
• LVDI does participate with ONE SOURCE MEDICAL yet.
• When scheduling need to get confirmation number.

Reduced Cost of Care (RCC)

•  When scheduling make sure to ask what percent is reduced.  If not 100% the patient must sign a waiver.

Royal Neighbors of America

• LVDI does NOT accept as primary insurance
• MEDLINK does their scheduling. LVDI is out of network
• As a secondary to Medicare - # on back of card must be called to ensure policy follows Medicare guidelines. We can accept if NOTHING is required. If it does NOT follow Medicare guidelines we cannot accept this card

SPECTRUM ADMINISTRATORS

• There are other insurances other than Choice Plus-please ask office/patient to clarify which insurance.
• Other than Choice Plus-offices must check to see if plan needs precert.

Sara Lee Corporation (employer) - via Valley Preferred

• For precertification of CT Scans call Definity Health 888.333.4648

SecureHorizons -thru United Healthcare

Provider ID: Secure Horizons-thru United Healthcare
• Medicare replacement plan
• As of July 1, 2010 authorization may be required for CT's, CTA's and PET scans.  Please call the number on the back of the patients id card.

Security 65

Selectus Coordinated Care- see Geisinger

Senior Blue

• See Capital Blue Cross when precerting thru NIA
• Prefix's YWK and YWW
• YWK needs authorization for CT's, CTA's and PET scans
• YWW is a PPO plan and does not require authorizations except for PET thru Capital BC NOT NIA
• Auth's thru NIA are NOT IV Contrast specific

Senior Partners/Health Partners

• Can accept as a secondary to Medicare
• Call number on card for precertification

Souderton Area School District (employer) - via Valley Preferred

• For precertification for CT scans call Inter-County Managed Care 800.952.3403

Standard Life and Accident Insurance Co.

State Farm

Provider ID: State Farm
•  This is a Medicare Supplement plan-follows Medicare guidelines-no authorization is needed

Sterling Life Insurance Company

TRICARE formerly CHAMPUS

• CHAMPVA is a different plan

Teamsters

• If the words Valley Preferred are on the card anywhere...we ACCEPT the card
• If the card states only DEVON and nothing else...LVDI CANNOT accept this card
• All cards must be checked for PRECERTIFICATION UNLESS ALL of the following words are on the card together: Central Teamsters PA, Devon, Health Assurance, Valley Preferred.  This is the only card that we are sure does NOT require precertfication. All others must be checked.
• Secondary to Medicare this does not require precertification
•  

Todays Option

• Medical Replacement plan

Trinity Industries (employer) - via Valley Preferred

• For precertification  call North America Health Plans 866.333.4648

UMR (UNITED HEALTHCARE)

• Sands employee's insurance
• NO precert or referral is required

UPMC for You

Provider ID: UPMC for You
• This is a new Medicaid plan
• LVDI or Lehigh Valley Hospital Network does not participate with this plan
• Patients must go to Sacred Heart Hospital or Reading Hospital for in network.

US FAMILY HEALTH PLAN

Provider ID: US FAMILY HEALTH PLAN
• **CT'S, CTA'S AND PET'S MUST be authorized by calling MEDSOLUTIONS 888.693.3211

USSA Life

Unicare - via Valley Preferred

• Scheduling through Raytel Imaging - Raytel must give a billing confirmation number prior to scheduling
• Raytel's phone # is 800-453-0574
• X-RAYS, ULTRASOUNDS, CT's , CTA's and PET scans need to be confirmed thru Raytel
• Offices will need to call the number on the back of the members ID card for billing confirmation(there is no set number to call for authorizaion)
• The Medicare Replacement plan does not need to go thru Raytel....this follows Medicare guidelines

Unison Health Plan

• As of February 1, 2011 Unison becomes United HC-Unison is no longer an insurance
• New United HC cards with have "COMMUNITY PLAN" in a box next to United HC. If an office says the patient has United HC you should be asking if the card has COMMUNITY PLAN on it. No auth needed for CTA's or CT's
• LVDI DOES NOT take the Unison Medicare Advantage plan-we are not considered in network
• CT and CTA'S no longer need authorization or referrals however PET scans do UNLESS "Gold Star" is on the card
• All plans except the Medicare Replacement and Supplement Plans require referrals for all other studies unless Gold Star Plan
• All PET SCANS still require auth.  Schedule 3 days out to allow for precert .Precerts will go through UNITED HEALTHCARE and the phone number will be listed on the back of the member ID card.

United American

Provider ID: United American
• This is a Medicare Supplement plan
• No referral or authorization is required

UnitedHealthcare - via Valley Preferred

• United Health uses the term "notification" the same way every other company uses the term "precertification"
• Offices must call 1-866-889-8054 for notification/certification for all PET Scans, CTA and CT scans.
• New United HC cards for the Unison Product will have the words "COMMUNITY PLAN" in a box next to United HC .When offices say the patient has United HC you should be asking if the card has COMMUNITY PLAN on it.  NO auth needed for CT's or CTA's .PET scans do need precert unless a GOLD STAR is on the card.
• If United Health Care is secondary to Medicare it does NOT need precert and is not plan related. 
• If United Health Care is secondary to any other insurance except Medicare, it still needs to be checked.
• Prenotifications are IV Contrast specific-the office must precert with or without IV Contrast specifically 
• NO referrals needed for any plans
• As of 8/26/11 UHC Community Plan no longer requires referrals.

Universal Healthcare

• This is a Medicare Replacement.
• To find out if a patient is capitated call provider services at 1-877-661-3920.
• There is a Radiology Authorization Request Form that needs to be filled out and faxed to 1-877-276-2410. See Melissa Good for this form.

Valley Preferred

• All Valley Preferred plans that require a precert or notification are listed below.  If a Valley Preferred plan is not listed below, it does NOT require anything.

Wellcare

Provider ID: Wellcare
• Medicare Advantage private fee for service plan. 
• No networks, patients have same benefits either in or out of network.
• No authorizations required

Wellpoint (BCBS)

• Blue Cross Blue Shield plan
• Check front and back of card
• Office calls number on card - plan related