2007 INSURANCE UPDATE 9 21 2007

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2007 INSURANCE UPDATE 9 21 2007 Powered By Docstoc
					                                                             ADVANCED RADIOLOGY CONSULTANTS
                                                                    INSURANCE MATRIX                                                   REVISED 4/15/2012
                                                                                                         Time
                                                         OFFICES
   Insurance Carrier            Product     Ins. Co                     Filing   Prior Authorization    Window           Referral                Phone #

                                                                                 OP SURG, CT, MR,                    HMO ONLY         PRE-CERT OBTAINED THRU
       AETNA/USHC                                                                                                                      MEDSOLUTIONS 800-575-
                                 HMO         1107       ARC, MRI       90 days     PET AND NM           90 days     Services not in    4417       CARECORE -
   ID -ALPHA/NUMERIC
                                                                                     CARDIAC                        the 70000 series        OUT OF STATE
                                                                                                                    require referral.
                                OPEN                                             OP SURG, CT, MR,                                        PRE-CERT OBTAINED
         AETNA                 ACCESS        Multi      ARC, MRI       90 days     PET AND NM           90 days            none          THRU MEDSOLUTIONS
  ID - ALPHA/NUMERIC           CHOICE                                                CARDIAC                                                 888-693-3211
                              POS QPOS
                                                                                 OP SURG, CT, MR,
   AETNA MEDICARE
                                             Multi      ARC, MRI       60 days     PET AND NM           90 days            none
      ADVANTAGE
                                                                                     CARDIAC
                              OPEN CHOICE
                               MANAGED
                                CHOICE
                                                                                 OP SURG, CT, MR,
          AETNA                  ELECT                  ARC, MRI       60 days     PET AND NM           90 days            none
                                CHOICE                                               CARDIAC
                                SELECT
                                CHOICE

                              TRADITIONAL
          AETNA                  CHOICE                 ARC, MRI       60 days           N/A            90 days            none
                               INDEMNITY


                                                                                                MAMMOS:
                                                                                                    1
                                                                                                BASELINE
                                                                               MRI,MRA,PET, CT,                                          PRE CERT OBTAINED
                                                                                                  35-39
     ANTHEM BC/BS                           MULTI       ARC, MRI      120 DAYS     NUCLEAR                                               THRU NIA 888-642-
                                                                                                    1-
                                                                                CARDIOLOGY                                                      4810
                                                                                                 SCREEN
                                                                                                 40+ PER
                                                                                                  YEAR
                                                                                                MAMMOS:
                                                                                                    1
                                                                               MRI,MRA,PET, CT, BASELINE                                 PRE CERT OBTAINED
 ANTHEM EMPIRE MEDI
                                            MULTI       ARC, MRI      120 DAYS     NUCLEAR        35-39                                  THRU NIA 888-642-
       BLUE
                                                                                CARDIOLOGY          1-                                          4810
                                                                                                 SCREEN
                                                                                                 40+ PER
                                                                                                  YEAR

                                                                                    GLOBAL
 BC/BS CONNECTICUT
                                                                                   CROSSING &
  GLOBAL CROSSING                                                                                                                        800-922-1742 x3220
                           almost all       MULTI     ARC, BRA, MRI               EMPIRE: CT'S -
 BC/BS NEW YORK TSJ                                                                                                                         203-375-6088
                                                                                  MRI'S - MRA'S -
 TEAMSTERS LOC 145
                                                                                 LOCAL MRI ONLY
                                                                      120 days
                                                        ALL ARC
BLUE CARE FAMILY PLAN Medicaid                          OFFICES                          N/A                                            888-582-1535
                                                      BPT MRI ONLY

                           PPO/PPA -                                              CALL # ON CARD
                           CALL # ON                    ARC, MRI                 CT, MRI, MRA, NM
                           CARD                                                   Cardio, PET, OP
CIGNA - PPO/PPA                                                                        SURG             30 days
                                                                                 CT, MRI, MRA, NM
                              HMO & POS                 ARC, MRI                  Cardio, PET, OP                                        pre-auth 800-859-5288
Cigna/AIM***                                10823                      90 days         SURG             30 days                            PAL: 800-841-3366

                                 PPO                    ARC, MRI
Cigna***                                     Multi                     90 days

                                                        ARC, MRI
Community Health Network       Medicaid      2539                     150 days                                                          800-842-8440
                                                                                   Consults, MRI,      ** LESS
  **CONNECTICARE
                                                                                  MRA, CT scan,        THAN 2
MEDICARE ADVANTAGE -                                    ARC, MRI      180 DAYS
                                                                                  PET, NM cardio,      YRS     30
      1/01/2008
                                 HMO        MULTI                                     **DEXA           DAYS                             NIA-877-607-2363

                                                                                  CT Scans, Pet,
Empire BC/BS                     HMO                    ARC, MRI
                                                                                 MRI, MRA, Nuclear
                                                                                                                                            1-800-982-8089
                                                                                    Cardiology


First Health/CCN                 PPO                    ARC, MRI                                                                            1-800-937-6824
                                                                                         N/A
Galaxy Health Network (GHN)      PPO                                                                                                          817-633-5822

GEHA/NON PAR                                            ARC, MRI                  MRI, MRA, CT,                                             1-800-821-6136
                                                                                 PET, NM Cardio
GREAT WEST/ONE
                                                        ARC, MRI
HEALTHPLAN                       PPO                                                  MRI,CT, PET                                            1-800-663-8081

Healthcare Value Mgmt.           PPO         7522       ARC, MRI      120 days           N/A                                                  800-922-4286
                                                        ARC, MRI                          NA                                            SEE INDIVIDUAL CARD
HEALTH CONNECTICUT               PPO        12654
Health Management                PPO         Multi      ARC, MRI                         N/A

HEALTHNET(PHS)** and                                                               MRI, MRA, CT,
                                                                                                                                        CARE CORE -
                                 HMO        MULTI       ARC, MRI
HEALTHNET GUARDIAN                                                                PET, NM Cardio                                        866-889-8059
                                                                      90 days                           30 days
                                                                                                                    GOLDEN RULE
                                                                                 MUST CALL # ON                     NO LONGER
                                                        ARC, MRI
                                                                                 CARD FOR AUTH                      PAR W/NEHC
HMC-PPO                          PPO        MULTI                                                                 c65843bd-d3ae-451a-957a-1ccf81961f13.xls
                                                                                                                    HMC PPO
                                                                          4/15/2012
         1
                                                               ADVANCED RADIOLOGY CONSULTANTS
                                                                      INSURANCE MATRIX                                                         REVISED 4/15/2012
                                                                                                               Time
                                                         OFFICES
   Insurance Carrier                Product   Ins. Co                     Filing     Prior Authorization      Window            Referral                Phone #
                                                                                       CT, MRI, MRA,                                                 800-453-4728
                                                        ARC, MRI                      Dexa, NM Cardio,                                          pre-auth          800-
Health Source (Cigna)                HMO      10823                      90 days       PET, OP SURG            30 days                                 859-5288

                                                        ARC, MRI                      NO CHIROPRACTIC
Medicare                                       1026                      18 mos          REFERRALS
Medlink                         HMO/PPO        7942     ARC, MRI                                N/A                                                  800-335-5465
                                                        ARC, MRI
Medview                              PPO      MULTI                      60 days                N/A                                                  800-772-5869
                                                        ARC, MRI
MultiPlan                            PPO      MULTI                      60 days                N/A                                                800-546-3887
Northeast Direct/Humana                                                                                                                            800-972-7830
                                                        ARC, MRI
Choicecare                           PPO       5215                     120 days                N/A                                             Humana - 800-626-2741
NYLCARE                              ppo                ARC, MRI
Oxford Health Plans***                                                                CT, MRI, NM, OP                       SERVICES NOT IN      OXFORD EXPRESS -
                                                                                                               45 DAYS
 Oxford Select Plans                                                                     Surg, MRA,          AUTHORIZATIO   THE 70000 SERIES        800-666-1353
                                     HMO      MULTI     ARC, MRI                                             NS REFERRAL
   NO REFERRAL                                                                          PET SCANS                           REQUIRE A                CARECORE
                                                                                                               NEEDED       REFERRAL
      NEEDED                                                                             3D RECON                                                   877-773-2884
                                                                         60 days

                                                                                                                                                USE INSURANCE THAT
  PHCS - MULTIPLAN
                                     PPO      MULTI      ARC MRI                                N/A                                              IS ON THE BACK OF
        5/1/07                                                                                                                                    INDIVIDUAL CARD
                                                                         60 days
                                                                                          Check individual
                                                        ARC, MRI                                                                                     800-334-5646
PPO/NEXT                             PPO       7065                                            plan            60 days
                                                                                                               date on
                                                        ARC, MRI
PREF ONE/FIRST CHOICE           MEDICAID                                 60 days                MRI             auth                                 800-925-3606


   EXISTING PATIENTS
     ONLYPLANNED                                        ARC, MRI                        CT Breast,
     PARENTHOOD                                7253                                   Cervix Screening                                               800-695-3131
Railroad Medicare                              3026     ARC, MRI         18 mos                                                                      800-438-7886


  STANDARD TRI-CARE                                     ARC, MRI                     MRI'S /MRA ONLY                                                 888-999-5195
                                               7176
                                                                                       12/03/2007
   UnitedHealthCare                                     ARC, MRI                      CT, MRI, MRA,            90 days                               800-860-5536
                                                                                                                            There are no
                                     PPO      MULTI                      60 days
                                                                                        PET, NM                             HMOs in CT
    New York State                                                                              New
   Employees w/ YLS                                     ARC, MRI                    York - MRI ONLY                         There are no              877-769-7447
        prefex                       PPO      MULTI                      60 days                               90 days      HMOs in CT
USI Administrators                   PPO       Multi    ARC, MRI                    Check individual plan      60 days                               800-573-9481
                                                                                     CT, MRI, MRA, OP
                                     PPO                ARC, MRI                          surgery                                                    877-899-9132
USI-Norwalk Hospital Emp.                                                                                      60 days

                                                                                        MRI, MRA,             VALID 1
                                                        ARC, MRI        180 DAYS
                                MEDICARE                                              PET,SPECT, CT          DAY ONLY                               1-866-579-8006
WELLCARE                                       5967
                                                                                            VERIFY
                                                        ARC, MRI
MEDICAID                                       1032                       1 year           COVERAGE                                                  800-842-8440
**Need prior authorization when secondary to another plan.

                                               **CIGNA PPO/PPA'S AUTH'S ARE GOOD ONLY FOR DATE ISSUED.

                                      IF THE PT. IS RESCHEDULED YOU NEED A NEW AUTH. # SAME AS PREFERRED ONE/FIRST CHOICE


                                                                                                               Time
                                                        Participation
   Insurance Carrier                Product   Ins. Co                     Filing     Prior Authorization      Window            Referral                Phone #
WORKERS COMP.                                                                             * SEE BELOW

                                                        ARC, MRI
ANCICARE/CARE IQ                     W/C                                                  * SEE BELOW                                                954-441-7600
CRA                                  W/C      MULTI     ARC, MRI                          * SEE BELOW
                                                        ARC, MRI
Connecticomp (Berkley Care)          W/C      MULTI                                       * SEE BELOW                                                800-445-1197

Corvel/Corcare                       W/C      MULTI     ARC, MRI                          * SEE BELOW

                                                        ARC, MRI
Focus                                W/C      MULTI                                       * SEE BELOW                                                800-680-1858
HealthDirect                         W/C      MULTI     ARC, MRI        90 days           * SEE BELOW
                                                        ARC, MRI
INDEPENDENT REVIEW                   W/C                                N/A               * SEE BELOW                                           315-699-4550 EXT. 108
International Specialist Services    W/C       9586     ARC, MRI        30 days           * SEE BELOW
MasterCare                           W/C       1744     ARC, MRI                          * SEE BELOW
Med Focus                            W/C       7277     ARC, MRI                          * SEE BELOW
One Call (CT's AND MRI's only)       W/C       2121     ARC, MRI                          * SEE BELOW        Date on auth                            800-872-2875
WCA                                  W/C      MULTI     ARC, MRI                          * SEE BELOW

                               * ALL SERVICES MUST BE AUTHORIZED BY THE COMP CARRIER

                               * IF ORBITS ARE PERFORMED, CARRIER MUST BE NOTIFIED
                                                                                                                         c65843bd-d3ae-451a-957a-1ccf81961f13.xls
                                                                              4/15/2012
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    ADVANCED RADIOLOGY CONSULTANTS
           INSURANCE MATRIX                               REVISED 4/15/2012




                                     c65843bd-d3ae-451a-957a-1ccf81961f13.xls
               4/15/2012
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    ADVANCED RADIOLOGY CONSULTANTS
           INSURANCE MATRIX                               REVISED 4/15/2012




                                     c65843bd-d3ae-451a-957a-1ccf81961f13.xls
               4/15/2012
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