AARP

• Usually secondary to Medicare

ACCESS

• There are several medical assistance plans. The most common Medicaid plan is ACCESS (also known as traditional - Medical Assistance(Yellow ACCESS card)
• NO authorizations needed secondary to Medicare
• LVDI provider # 0011766440001 for PET scans, CT, AND CTA'S-MA does not use our tax ID #
• As of 9/1/08 CT'S and CTA'S will now require authorization. Offices must call 800-558-4477 to get authorizaions for PET scans, CT'S, AND CTA'S.
• Access card can be used with another insurance card
• Ask if patient has an additional card
• As of 3/1/13, Access Plus is no longer active. We should not be coping this card.

AETNA BETTER HEALTH

• PA Medicaid product so follows medical assistance guidelines
• Eligibility changes monthly so patients will need to sign a waiver. 
• There are 2 different Aetna Better Health's. One is Medicaid and is NOT through Aetna (cannot be verified on Navinet) and one IS through Aetna (can be verified on Navinet).
• If it is the product through Aetna, regular Aetna rules as far as a referral will need to be followed.
• 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.

Access America thru UHC

• This card states UHC and Access America.
• It needs auth through NIA.

Advantra

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

Aetna

• https://navinet.navimedix.com/
• HMO- 99098 or Traditional non-HMO(PPO)- 4450981
• PET ONLY: for "W" plans- providers must call 888-632-3862 to get benefits first then ask if the plan requires precert! Get name of rep and what facility they are from.  ALL HMO plans need auth for PET scans.. 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 will not. Some HMO plans are capitated (which means patients insurance has already paid for them to go to another facility). LVDI cannot accept this plan without a referral from the patient's PCP.
• Medicare cards start with "ME" then numbers. See grid for referral information.
• NAP is not a plan, ask for more information. NAP is for hospital, not outpatient
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY-please see information listed on the home page of NIA website under AETNA
• As of 4/23/12, CT Virtual Colonoscopies need auth thru MedSolutions.

 

AliCare

• Medicare Supplement

AmeriHealth via Independence Blue Cross

• https://navinet.navimedix.com/
• Provider ID: 0385099000
• NOT AmeriHealth Mercy or AmeriHealth TPA
• For precertification  call AIM 800.859.5288
• Precertifications are not IV Contrast related
• CORONARY CTA'S are covered based on authorization by AIM 800-227-3116
• 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
• Call 1-877-385-6243 to check for precert.

AmeriHealth Caritas

Provider ID: 47798
• 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
• AmeriHealth Caritas is formally AmeriHealth Mercy.

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. 
• As of 5/20/13, AmeriHealth Mercy is now know as AmeriHealth Caritas.

AmeriHealth Northeast

• Plan begins 3/1/13.
• Be aware, this IS NOT AmeriHealth Mercy.
• This is the plan taking over for Access Plus.
• Provider Service # is 1-888-208-7370.
• For precertification call 1-888-498-0504.
• If an office needs a phone number for their docs to do a peer to peer the phone number is 1-888-743-5551.

AmeriHealth VIP Care

• This is NOT AmeriHealth Mercy.
• LVDI is "out of network" with this insurance.
• This is a dual eligible plan that began 1/1/13.

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-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 , PET/CT and CTA's depend upon 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, PET and CTA
• Office must call # on back of card if scheduling a CT, PET and CTA
• Ask office to check back of card for precertification requirements as a secondary insurance

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 NOTcontrast related.

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 patients 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 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
• Secondary to Medicare nothing needed.
• For precertification requirements call number on back of card.
• Offices with have to have our company information entered manually, and auth will pend for facility check.

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 or phone #; 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
• All other studies require nothing.
• Use BCBS button for entire listing of BCBS plans
• Coverage critiera for Coronary CTA's is listed on the home page of NIA's website under each individual state.

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, CTA, or PET, no need to be specific as no referrals are required with any study.
• Secondary to Medicare or Medicare Replacement nothing needed.
• If patient has a Blue Card plan, offices with have to have our company information entered manually, and auth will pend for facility check.

BlueCross/Blue Shield of South Carolina

• Offices should call NIA for authorizations at            1-866-500-7664       

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/
• Coronary CTA's are currently not covered however exceptions are made under certain criteria.
• For the new BCBSFlorida prefix HHM auth's offices are to call 1-888-376-6544.

CareFirst BlueCross BlueShield (BCBS)

• Ask for more detailed information
• Check card for website
• Secondary to Medicare or a Medicare Replacement nothing needed.

 

Caremark

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

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 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
• Choice Plus 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.

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  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.
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY-please see information listed on the home page of NIA's website under CIGNA. 
• 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.

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 required

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 from card.
• This is not a plan

Coventry Healthcare Plan

• see HealthAmerica
• As of 4/1/12, LVHN is NOT IN PAR with Coventry Cares.

Dental Care Alliance (employer) via Valley Preferred

• For precertification  call SYNERGY 800.796.7587

Devon Healthcare

• 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.
• If it does not have Central Teamsters or Valley Preferred on card, ask if card states "One Call Medical". If it does, we cannot accept period. If pt comes here, they will get a bill. See Melissa Good for example of card.

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.

Empire Plan thru United Healthcare

• This is a blue card and usually has an outline of the state of New York on it.
• Office needs to call 1-888-333-9067 to check for authorization.
• This is CPT code specific.

Excellus BlueCross BlueShield www.excellusbcbs.com (BCBS)

• Precertification is required for some CT scans for certain plan members. 
•  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 yet in PAR- Cannot accept at this time
• There is a plan under First Health called First Health Plus.  This is a true Medicare Supplement and LVDI WILL accept as it follows Medicare guidelines.
  

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 BC/BS plan thru Blue Cross Northeastern 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 1-866-262-5623.
• Secondary to Medicare nothing needed
• If patient has a Blue Card plan, offices will have to have our company information entered manually, and auth will pend for facility check.

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 Head, Sinus, 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
• For precertification call NIA 888.879.5922 (On Line Precertification is not yet available)
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY-please see information listed on the home page of NIA website under GATEWAY.
• As of JAN 1, 2011 DEXA scans do NOT require a precert.
• As of Jan 1, 2013 CT's and PET's NO LONGER require authorizations.
• As of Jan 1, 2013 ultrasounds NO LONGER require referrals.

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  call NIA 866.305.9729 OR precert ON LINE through http://www.radmd.com/
• NIA authorizations are NOT IV Contrast specific
• Coronary CTA's are currently not covered however exceptions are made under certain criteria.

 

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 call MEDSolutions 888.693.3211 or precert on line www.medsolutionsonline.com
• The insurance card does not need to specify VALLEY PREFERRED

HOP - Health Options Program

Hamon Corporation (employer) via Valley Preferred

• For precertifcation  call Healthcare Strategies 888.599.1515

Hartford Life Insurance

Harvard Pilgrim Health Care

• This is Access America thru UHC.

Health Net

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

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

• Precerts are necessary if secondary to Medicare and all 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.

HealthGuard - NO longer available

Highmark Blue Shield www.highmark.com (BCBS)

• https://navinet.navimedix.com/
• Provider ID: 563802
• Be VERY specific about which Highmark plan.
• All CTA's require precert
• 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 authorization phone # for NIA is 866.731.8080.  Press Option #4. 
• Can also call 1-888-642-4814.
• Authorization thru NIA is NOT IV Contrast related
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY-please see information listed on the home page of NIA website under HIGHMARK.
• 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.

Horizon BlueShield/Horizon NJ+

• Horizon Blue Shield/Horizon NJ plus-Benefits through local BlueCross BlueShield
• Horizon NJ Health (different from above plan)- This plan is available to only New Jersey residents and is a state funded program for individuals in the medicaid and NJ Family Care programs. LVDI should not see these plans.
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY-please see information listed on the home page of NIA website under HORIZON.
• Horizon BC/BS secondary to Medicare does not need a precertificaton

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.

IBxpress (BCBS)

• Another BlueCross BlueShield Plan
• 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  call Inter-County Hospitalization Plan 800.952.3404

Independence Administrator

Provider ID: Independence Administrator
• Formerly Amerihealth Administrators
• Call 1-877-385-6243 to check for precert.

Independence BlueCross

• https://navinet.navimedix.com/
• If the card reads Independence BlueCross Highmark BlueShield check website of card, and if website consists of "highmark" then this is true highmark plan, see highmark on grid.
• 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 or possibly precert
• Referrals are obtained from PCP or ordering physician.
• For precertification of AmeriHealth Mercy plans call MedSolutions at 1-800-572-1981.  Precerts thru MedSolutions are IV Contrast specific. CORONARY CTA'S are covered based on authorization by AIM 800-275-2583 option 3.
• 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.
• To obtain authorizations thru AIM call 1-800-275-2583 option "3".

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

• If a plan is capitated; the insurance plan has already paid for the patient to go to another facility; out of network referral required. Many of these plans under Keystone East are Capitated.  It is very difficult and rare to obtain an out of capitation or network referral or authorization.  Please be sure to check if patient is capitated to go to another facility prior to scheduling any CT, PETs and CTA's.
• For Precertificatin of CT Scans call AIM 800-275-2583 hit prompt #3. Precerts thru AIM are NOT IV Contrast specific.
• For Precertification of CT Scans call AIM 800-275-2583 - Press option #3.
• CORONARY CTA'S are covered based on authorization by AIM 800-275-2583.
• 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 call 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 First

• AS OF 3/7/12 LVDI IS NOW OUT OF NETWORK PT CANNOT COME HERE!!
• Provider number is 30002384
• If patient is approved by Keystone First 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
• Formerly known as Keystone Mercy.

Keystone Mercy Health Plan (Medicaid)

• AS OF 3/7/12 LVDI IS NOW OUT OF NETWORK PT CANNOT COME HERE.
• 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, PETs and CTA scans call MedSolutions at 1-800-572-1981. Precertications ARE contrast related. If patient is approved to come to LVDI for studies other than CTor PET and CTA, out of network referrals are required.  Precertification if required for all CT's, PETs and CTA's.
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY
• Now known as Keystone First as of 4/24/13.

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

Lehigh Select (Tier 1)

• See Health America

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

MAGNACARE

• LVDI is considered in network as of 1/1/13 if card has Valley Preferred on it.
• Call the number on the back of the patient's card for information about referral or auth needs.

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 choice between Keystone 65 Select HMO and Keystone 65 Preferred HMO.
• LVDI and LVHN is NOT IN PAR with Keystone 65 Select HMO.

Medicare Supplement Plans

Meritain

• This is a plan that should also say Aetna and Valley Preferred on the card.
• Per Meritian, offices are to call Coordinated Healthcare at 1-800-247-8956 to check for auth.
• Website is www.chc-care.com

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 Era Life

• This is a Medicare Supplement.

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

OmniCare

• If card states MulitPlan on it, pt is able to come here.
• If card DOES NOT state MultiPlan, LVDI is not in PAR and patient cannot come here.

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.
• Offices can call 1-800-872-2875 and ask for scheduling department.
• When calling One Call tell them we need a "Single Case Agreement" for a group health claim

Oxford Health Plans - via Valley Preferred

• Provider ID: A3479868
• For precertification call Care Core at 1-877-773-2884. Precertifications now do go through CareCore. Oxford treats PA physician providers differently. 
• Oxford secondary to any other insurance MUST be precertified ...2ND to MEDICARE does not need precert!
• Must have correct CPT codes as they are contrast related authorizations.
• These authorizations usually begin with "A"

PATHS

• This is for patient's who are MA Pending. They may come here, but need to sign waiver.

PEBTF

• If the card states "Capital Blue Cross" ANYWHERE on it - please see Capital Blue Cross.
• If "Capital Blue Cross" is NOT on the card it is then a true PEBTF, which is usually secondary to Medicare.
• Second to Medicare straight PEBTF does not require precert for CT's, CTA's or PET.

PHCS

• 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
• If card has any other insurance listed IE: MULTIPLAN, BEECHSTREET OR VALLEY PREFERRED we will take as primary and bill one of these insurances

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

Pabst Brewing Company

• This is a retiree benefit plan that is secondary to Medicare.

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 800-275-2583. Precerts thru AIM are NOT IV Contrast specific.
• CORONARY CTA'S are covered based on authorization by AIM 800-227-3116

Qualcare PPO

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)

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

Sara Lee Corporation (employer) - via Valley Preferred

• For precertification  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.
• Be aware there is a Secure Horizons Medicare supplement plan. This card does say "United Healthcare Secure Horizons Medicare Supplement" on it.

 

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
• Authorizations thru NIA are NOT IV Contrast specific
• YWW is a PPO plan and does not require authorizations except for PET thru Capital BC NOT NIA

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  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.  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

Trinity Industries (employer) - via Valley Preferred

• For precertification  call North America Health Plans 866.333.4648

UMR (UNITED HEALTHCARE)

• 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 have a billing confirmation number prior to scheduling.
• Raytel's phone number 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 -NO auth needed for CT's or CTA'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 office is a  "Gold Star" provider.
• 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

• UHC uses the term "notification" the same way every other company uses the term "precertification"
• New United HC cards for Unison Product will have the words "COMMUNITY PLAN" in a box next to United HC -NO auth needed for CT's or CTA's .PET scans do need precert unless doctors of is a GOLD STAR provider.
• For all United Health plans call 1-866-889-8054 for prenotification to obtain a number.
  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.
• Coverage critera for Coronary CTA's is based on MEDICAL NECESSITY and providers must call for precertification 866-889-8054
• 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.

Valley Preferred

• Plans listed below are the only plans that require precert.  If a Valley Preferred plan is NOT listed, nothing is required.