HOP - Health Options Program
|
| Standard Option - Medicare Supplement plan |
No |
No |
Hamon Corporation (employer) via Valley Preferred
- For precertifcation of CT Scans call Healthcare Strategies 888.599.1515
|
| |
No |
Yes CT, PET and CTA |
Hartford Life Insurance
|
| Medicare Supplement Plan |
No |
No |
| Berkshire |
Cannot Accept-Non Par |
Cannot Accept-Non Par |
Harvard Pilgrim Health Care
- This is Access America thru UHC.
|
| |
No |
Yes-thru NIA |
Health Net
- LVDI is NOT PAR and CANNOT ACCEPT at this time.
|
| Health Net |
LVDI-CANNOT ACCEPT |
LVDI - CANNOT ACCEPT |
HealthAmerica, HealthAssurance, Lehigh Select (Tier 1) Coventry Healthcare Plans via Valley Preferred
- 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.
- As of 4/1/12, LVHN is NOT IN PAR with Coventry Cares. See Melissa Good for an example of the card.
|
| Health America |
No |
Yes CT, PET and CTA |
| Health Assurance |
No |
Yes CT, PET and CTA |
| Lehigh Select (Tier 1 only) -Tier 2 and 3 are non par or out of network plans |
No |
Yes- CT, PET and CTA |
| Advantra Medicare Advantage HMO and PPO Plan |
No |
Yes- CT, CTA and PET |
| Advantra Freedom (Follows Medicare guidelines) |
No |
No |
| Coventry Cares |
NOT IN PAR |
NOT IN PAR |
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 Highmark plan.
- 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
- Can also call 1-888-642-4814.
- PLEASE INFORM OFFICES THEY ARE TO CALL NIA FOR AUTH NOT HIGHMARK. HIGHMARK IS TELLING OFFICES NO AUTH NEEDED WHEN IT IS REQUIRED.
- As of October 15, 2012 Highmark will require auth for CT's of the Head, Sinus, Chest, Abdomen, and Pelvis, PET scans, and all CTA's reguardless of body part.
|
| ClassicBlue |
No |
No |
| Signature 65 - Medicare Supplement |
No |
No |
| MedigapBlue - Medicare Supplement |
No |
No |
| Security 65 - Medicare Supplement |
No |
No |
| Federal Employee "R" |
NO |
NO |
| Special Care |
No |
NO |
| FreedomBlue - Medicare Replacement |
No |
Yes CT (head,sinus,chest,abdomen,pelvis) PET and CTA |
| DirectBlue |
No |
Yes CT (head,sinus,chest,abdomen,pelvis) PET and CTA |
| PPOBlue |
No |
Yes CT (head,sinus,chest,abdomen pelvis) PET and CTA |
| Chip |
No |
Yes CT (head,sinus,chest,abdomen,pelvis) PET and CTA |
| SelectBlue |
No |
Yes CT (head,sinus,chest,abdomen,pelvis) PET and CTA |
| Adult Basic |
No |
Yes CT (head,sinus,chest,abdomen, pelvis) PET and CTA |
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.
|
| Horizon NJ Health-For NJ residents only-LVDI not in par |
LVDI not in par |
LVDI not in par |
| Horizon BlueShield/Horizon NJ Plus |
No |
Plan related-call numb on back of pt's id card |
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.
- Offices can call 1-866-825-1550 for authorizations.
|
| Humana Gold Choice - Medicare replacement plan- no contracts or networks |
No |
No |
| Humana - NOT IN PAR |
Plan Related-Call |
Plan Related-Call |
| Medicare Supplement |
NO |
NO |
| Humana PFFS |
NO |
NO |
| Humana Choice PPO - Medicare PPO- Regional PPO- not in par but offers out of network with a phone call from referring physician |
NO |
Plan Related-Call |