| MANAGED CARE COMPANY |
Pre-Certification Rules |
Contact Information |
| AETNA |
Aetna Choice POS/ Aetna Choice POS II
Aetna Health Fund
Aetna HMO
Aetna Open Access Elect Choice EPO
Aetna Open Access HMO
Aetna Open Access Managed Choice (POS)
Elect Choice (EPO) Managed Choice (POS)
Open Choice (PPO)
Quality Point-of-Service (QPOS)
USAccess |
MRI, CT, Nuc Med (for patient ID’s starting with W) |
Pre-certification by Care Core www.carecorenational.com
800-420-3471 |
| Aetna Chickering |
MRI, CT Columbia University students: referral from ordering physician must be on file. All other Chickering patients: please call the number on the back of the card. |
800-966-7772
www.chickering.com |
| CIGNA |
Cigna Care Network
Cigna Choice Fund
Network
HMO
HMO Open Access
Open Access Plus In-Network
POS Open Access
POS
Network Open Access
Open Access Plus |
MRI, MRA, NUC MED (Brain SPECTS only) CT precertification requirements will vary by plan. |
Precertification by American Imaging Management www.americanimaging.net
800-252-2021
|
EPO
PPO |
Plan rules vary: Call number on back of card |
800-244-6224
www.cigna.com |
| Empire BCBS |
Child Health Plus
Direct HMO
Direct Pay HMO
Direct Pay Hmo/POS
Direct POS
DirectShare POS
Empire Total Blue
EPO
Family Health Plus
Healthy NY
HMO
PPO
Senior Plan
WellChoice HMO
Unicare
|
Precertification requirements will vary by plan. Check insurance card. Call or consult NIA website to verify. |
Precertification by National Imaging Associates; 800-676-2583
www.radmd.com |
| Federal Employee - (ID begins with the letter "R") |
No precertification required |
|
| Health Net |
Charter HMO
Charter POS
Charter Traditions
Passport HMO
Passport POS
PPO |
MRI, CT & Nuc Med: Precertification required |
Precertification by Care Core
877-773-2884
www.carecorenational.com |
| Oxford |
Freedom Plan Select
Freedom Plan
HMO Select/Liberty
Liberty Plan
Liberty Plan Select
Medicare Advantage Balance
Medicare Complete Essential
(formerly Medicare Advantage Essential)
Medicare Complete Mosaic
(formerly Medicare Advantage Mosaic)
Medicare Complete Plan 1
(formerly Medicare Advantage Signature)
Medicare Complete Balance
(formerly Medicare Advantage Balance)
Evercare Plan DH
(formerly Medicare Advantage Select) Medicare Complete
(formerly known as Medicare Advantage)
Medicare Complete Retiree Plan
(formerly known as Medicare Group Account) |
MRI & CT (Denta Scan -70486) & Nuc Med: Precertification required. (New Jersey small business and New Jersey school board plans do not require precertification) |
Precertification by Care Core www.carecorenational.com
877-773-2884 |
| United Healthcare |
Select Plus
Choice Plus
Options PPO |
CT, MRI & Nuc Med. Precertification requirements will vary by plan. Out of state residents having exams in NY will most likely require authorization. Please call or consult the website to verify. |
Precertification by Care Core:
877-773-2884
www.carecorenational.com |
| Worker Compensation |
|
CT & MRI: Requires an authorization letter from the WC carrier |
|
| No Fault |
|
No pre-certification required. Case number, carrier name, address and date of accident are required. If out of state accident written authorization from insurance company may be required; NYS accident not required. |
|
| Community Premier Plus |
Please check the back of the card |
|
| United Healthcare-Empire Plan |
MRI only |
877-769-7447 |
| Railroad Medicare |
No precertification required |
|
| Multiplan |
Will vary by plan. Please call the number on the back of the card |
|
| Local 32BJ |
Administered by Blue Cross Blue Shield - Check the back of patient’s card |
| 1199 |
No precertification required |
|
| Medicare |
No precertification required |
|
