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
  No Plan Related-Call

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.

     

 Y W K - Senior Blue **Medicare replacement plan** No Yes- CT, PET and CTA
 ZZC, ZZD and ZZP LVDI cannot accept LVDI cannot accept
 P F P - PEBTF -(IF SECONDARY, NO AUTH NEEDED) No Yes- CT, PET and CTA
 Y W V - Keystone Central **(IF SECONDARY INSURANCE NO AUTH NEEDED) No Yes- CT, PET and CTA
 AIR NO YES-PET only
 YWW- Senior Blue PPO NO YES-PET only
 P E B - PEBTF No Yes-PET only
 BCBSFlorida-Prefix HHM No Yes

CareFirst BlueCross BlueShield (BCBS)

    • Check card for website
    • Secondary to Medicare or Medicare Replacement nothing needed.
 BlueChoice Open Access Yes ALL-except CT, PET and CTA Yes- CT, PET and CTA
 BlueChoice HMO Yes ALL-except CT, PET and CTA Yes- CT, PET and CTA
 BlueChoice Preferred (PPO) No Plan Related-Call

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.
 Carpenter's NO NO

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 Health and Welfare Fund; Devon; Health Assurance . 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 484-884-0417
    • CT VIRTUAL COLONOSCOPIES REQUIRE PRE-NOTIFICATION
    • PET CT'S NOW REQUIRE A PRE-NOTIFICATION-providers should call 484-884-0417
    • Calcium scoring is covered as screening
    • Demographics and other info needs to be faxed to 484-884-0008.

     

  No YES-PET, CT VIRTUAL

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.
    • Be advised, if an office orders 3D reconstruction, it will need an auth for this portion of the study. Even if the body part itself does not need auth. The CPT code for 3D reconstruction is 76377.
  No Ref - must have Script from office Plan Related-see note above if office also request 3D reconstruction

Colonial Healthcare - via Valley Preferred

    • Usually this is secondary to Medicare
  No No

Connecticut General and Life (CIGNA)

    • We can no longer use the old way of thinking which is if "outpatient" is on the back of the card auth is needed. This is not correct anymore. All Cigna's are plan related no matter what the card states.
 Cigna No REF,script from PCP Plan Related

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
    • As of 4/1/12, LVHN is NOT IN PAR with Coventry Cares. See Melissa Good for an example of this card.
 Coventry (thru Health America) NO Yes-CT's, CTA's and PET scans
 Coventry Cares NOT IN PAR NOT IN PAR