INSMATRIXNEWYORK.xls by longze569

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									                                                                      Doshi Diagnostic Imaging Services of New York




                                                                                LAST UPDATED ON 06/18/2007



                                                                               INSURANCE MATRIX 2007




                                                   Please make note of recent changes in regards to the following insurance companies:

                                6/18/2007
                                                   NEIGHBORHOOD                                                                  see New Updates


                                6/18/2007

                                             TRUSTMARK LIFE INSURANCE CO                                                         see New Updates




                ***Please be advised: This insurance matrix is updated quarterly. While the best efforts are made to insure accuracy, insurance
               companies change their guidelines occasionally. Please contact the insurance company in the event of any discrepancies. Their
            telephone numbers can be found within our comment column. If you need further assistance, please contact a DOSHI center manager.




6/30/2010                                                                      PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                     NPI DOSHI # 1720031339//Page 1
                                                                                                          Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                              AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                      CT SCAN &                                                                  NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                     CT                                                                    MEDICINE &       BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                   SONO          MAMMO          X-RAYS                                                         CLAIM CENTER                         COMMENTS
                           ELIGIBILITY                                            PETCT                   ANGIOGRAPH                                                                  NUCLEAR         BIOPSY
                              FORM                                                                             Y                                                  VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                         STUDIES     ECHO

                                                                                YES, 1199
                        ELIGIILITY                                                                                                                                                                                                      FOR AUTHORIZATIONS FOR 1199 HOME CARE
                                                               DOCTORS           & HOME                                                                                                                           PRI- (1199 NAT) #
     1199 NATIONAL       MUST BE                                                                                                                                                                                                         MEMBERS, CALL CARE REVIEW AT 800-227-
                                                               REFERAL            CARE          NO           NO           NO             NO             NO               NO     NO       NO            NO        08785 HOME CARE
     BENEFIT FUND        VERIFIED                                                                                                                                                                                                        9360 ,,, FOR 1199 MEMBER ELIGILITY CALL (
                                                               NEEDED           MEMBER                                                                                                                           MEMBERS PRI# 08310
                        BY PHONE                                                                                                                                                                                                                          646) 473-7446
                                                                                    S                                                                                                                                SEC # 08332
  ACCESS HEALTH &                                                                                                                                                                                    NEED TO
                  ELIGIILITY
   SERVICES OF NY                                              DOCTORS          PATIENTS WILL HAVE ACCESS INSURANCE CARD AND DR'S REF OR SCRIPT. ONLY ACCEPT CALL INS &
                   MUST BE
   4024 AVENUE U                                               REFFERAL         CASH,CHECK OR CREDIT CARD. FOR FEE SCHEDULE GO TO /M13 OPTION #1 AND LOOK FOR VERIFY IF                                           SELF PAY #00731               THIS IS A DISCOUNT PLAN*
                   VERIFIED
    BROOKLYN NY                                                 NEEDED                                      ACCESS HEALTH INS FEE.                             AUTH
                  BY PHONE                                                                                                                                                                           NEEDED
        11235

                        ELIGIILITY
     ADAP PLUS (NY                                             DOCTORS                                                                                                                                                                      ADAP IS A GOVERNMENT PLAN FOR
                         MUST BE                                                    ADAP ONLY COVERS CHEST X-RAY ONCE A YEAR, THEY WILL NOT COVER ANY
        STATE                                                  REFFERAL                                                                                                                                             PLAN#N 9972          UNINSURED PATIENTS. (ONLY ALLOW ONE
                         VERIFIED                                                                              OTHER TEST.
     DEPARTMENT                                                 NEEDED                                                                                                                                                                            CHEST XRAY A YEAR).
                        BY PHONE

                                                                                                                                                                                                       AUTH
                                                                                                                                                                                                     NEEDED
                                                                                                                                                                                                    DEPENDIN
                                                                                                                                                                                     YES, ONLY
                                                                                                      YES, AS OF                                                                                       G ON
                                                                                YES, AS OF YES, AS OF                                                                                 NUCLEAR
      AETNA - *** ALL                                                                                  5/1/2007                                                                                      MEMBERS
                      NEED AETNA                                                 5/1/2007   3/1/2007                                                                                 CARDIOLOG
      COMMERCIALS                                               DOCTORS                                 THRU                                                                                        PLAN ,CALL                          ID # START WITH THE LETTER W // FOR AUTH CALL
                       WEB SITE                                                   THRU       THRU                                                                                     Y ** AS OF
   PLAN * PPO, EPO **                      WWW.AETNA.COM        REFFERAL                              CARECOR             NO             NO             NO               NO     NO                    AETNA          BILLL # 08885               CARECORE AT 1-888-622-7329 /OR
                      ELIG PRINT-                                               CARECORE CARECORE                                                                                      5/1/2007
    (ID# STARTS WITH                                             NEEDED                               E 888-622-                                                                                      DIRECT                                    WWW.CARECORENATIONAL.COM
                         OUT                                                     888-622-   888-622-                                                                                    THRU
      THE LETTER W)                                                                                   7329 ALSO                                                                                        AND
                                                                                   7329       7329                                                                                    CARECORE
                                                                                                         CTA                                                                                          VERIFY
                                                                                                                                                                                     888-622-7329
                                                                                                                                                                                                     WHETHER
                                                                                                                                                                                                      AUTH IS
                                                                                                                                                                                                     NEEDED




                    NEED AETNA
  AETNA TRADITIONAL                                             DOCTORS
                     WEB SITE                                                                                                                                                                                                           NO AUTH NEEDED FOR THE TRADITIONAL CHOICE
  CHOICE (INDEMNITY                        WWW.AETNA.COM        REFFERAL           NO           NO           NO           NO             NO             NO               NO     NO       NO            NO            BILLL # 08885
                    ELIG PRINT-                                                                                                                                                                                                                     (INDEMNITY PLAN)
        PLAN)                                                    NEEDED
                       OUT




                                                                                                                                                                                        YES,ALL
                                                    USHC REFERRAL
                                                                                                                                                                                       NUCLEAR
                                                    NEEDED FOR ALL                                                                      NO/                                           MEDICINE &
                                  FOR ELIGIBILITY    90000'S SERIES,                                                                 ROUTINE                                           NUCLEAR      YES, CALL
  AETNA HMO GOLDEN NEED AETNA                                                                YES, ALL     YES, ALL                                                                                                                           FOR AUTH CALL CARE CORE AT 888-622-7329
                                 WWW.AETNA.COM       NEED REF FOR                                                                    MAMMO                                           CARDIOLOGY       AETNA
   MEDICARE PLANS(  WEB SITE                                                     YES, thru   MRA'S &        CT'S                                                                                                                         ...GOLDEN MEDICARE PLAN REPLACES MEDICARE
                                    // FOR AUTH       93015 WHEN                                                          NO         FOR AGE            NO               NO     NO        -FOR      DIRECT AT    CLAIM CENTER # 00351
    ALL MEDICARE   ELIG PRINT-                                                   Care Core   MRI'S thru   EXCEPT                                                                     CARDIOLYTE 800-223-6857
                                                                                                                                                                                                                                          .           FOR BREAST BIOPSY STUDIES CALL
                               WWW.CARECORENATIONAL      DOING                                                                      40+ COVER
       PLANS) *       OUT                                                                    Care Core     DEXA                                                                        GET AUTH      OPTION 3                                  AETNA DIRECT 800-223-6857 OPTION 3
                                        .COM         CARDIOLYTE &                                                                    ONE PER
                                                                                                                                                                                       FOR 78465-
                                                        STRESS                                                                        YEAR
                                                                                                                                                                                      78478-78480
                                                       THALLIUM.                                                                                                                      thru Carecore




                                                     USHC REFERRAL
                                                     NEEDED FOR ALL                                                                     NO/                                             YES,ALL        AUTH                            FOR AUTHORIZATION CALL CARE CORE. CALL AT 1- -
                                                                                                                                                                                       NUCLEAR        NEEDED     CLAIM CENTER # 04136
                                   FOR ELIGIBILITY    90000'S SERIES,                                                                ROUTINE                                                                                                  888-622-7329 OR CHECK THE WEB SITE:
                    NEED AETNA                                                                            YES, ALL                                                                    MEDICINE-     DEPENDING     (REVIEW DEPT BILL #
                                  WWW.AETNA.COM       NEED REF FOR                           YES, ALL                                MAMMO                                                                                                 CARECORENATIONAL.COM /// THE REFERRING
   AETNA -HMO RISK   WEB SITE                                                                               CT'S                                                                          FOR           ON        00351 IF NEEDED (FEE
                                     // FOR AUTH       93015 WHEN                  YES       MRA'S &                      NO         FOR AGE            NO               NO     NO                                                      PHYSICIAN MUST OBTAIN THE PRE-CERTIFICATION .
   COMMERCIAL PLANS ELIG PRINT-                                                                           EXCEPT                                                                     CARDIOLYTE      MEMBERS     FOR SERVICES. (CHECK
                                WWW.CARECORENATIONAL      DOING                               MRI'S                                 40+ COVER                                          GET AUTH     PLAN/CALL                          AUTH ARE GOOD FOR 45 DAYS ONLY.      FOR BREAST
                       OUT                                                                                 DEXA                                                                                                  THE RISK LIST FOR PCP
                                         .COM         CARDIOLYTE &                                                                   ONE PER                                          FOR 78465-       AETNA                            BIOPSY STUDIES CALL AETNA DIRECT 800-223-6857
                                                                                                                                                                                                                            #)
                                                         STRESS                                                                       YEAR                                            78478-78480     DIRECT                                                OPTION 3
                                                        THALLIUM.




6/30/2010                                                                                                              PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                     NPI DOSHI # 1720031339//Page 2
                                                                                                         Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                             AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                     CT SCAN &                                                                  NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                    CT                                                                    MEDICINE &      BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                          CLAIM CENTER                              COMMENTS
                           ELIGIBILITY                                            PETCT                  ANGIOGRAPH                                                                  NUCLEAR        BIOPSY
                              FORM                                                                            Y                                                  VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                        STUDIES     ECHO



                                                                                                                                                                                                                                             FOR AUTH CALL CARE CORE AT 1-888-622-7329 OR
                                                                                                                                                                                                                                             CHECK THE WEB SITE: CARECORENATIONAL.COM//
                                                                                                                                                                                                                                            THE REFERRING PHYSICIAN MUST OBTAIN THE PRE-
                                                                                                                                                                                                                                              CERTIFICATION .. ERFORMING MORE THAN TWO
                                                                                                                                                                                                                                             PROCEDURES THAT NEED PRE-CERT ON THE SAME
                                                                                                                                                                                                                                               DAY, YOU WILL NEED PRE-CERT FOR EACH ONE.
                                                                                                                                                                                                              90000'S BILL-# PRI-SEC #
                                                                                                                                                                                                                                            EXAMPLE FOR CARDIOLYTE TEST AUTHO IS NEEDED
                                                                                                                                                                                                              00 351 (NEED USHC REF).
                                                                                                                                                                                                                                                       FOR 78465 & 78478 AND 78480.
                                                                                                                                                                                                                70000,S & CONTRAST
                                                                                                                                                                                                                                            ( AUTHORIZATIONS ARE GOOD FOR 45 DAYS ONLY )
                                                                                                                                                                                     YES, ALL                  UNDER $50 BILL#04136
                                                                                                                                                                                     NUCLEAR        AUTH        FOR 58340 INJECTION
                                                                                                                                                                                    MEDICINE       NEEDED         BILL # 00351 FOR
                                                      USHC REFERRAL                                                                    NO/
  AETNA- CARECORE** NEED AETNA                                                                                                                                                      NEED PRE-     DEPENDIN A9500,A9505, A4646 BILL
                                   FOR ELIGIBILITY    NEEDED FOR ALL                                                                ROUTINE
      HMO, QPOS,      WEB SITE                                                                           YES, ALL                                                                      CERT          G ON                # 04136
                                  WWW.AETNA.COM       90000'S SERIES &                       YES, ALL                               MAMMO
      US ACCESS     ELIG PRINT-                                                                             CT's                                                                        FOR       MEMBERS           ISOTOPES, ,AND
                                     // FOR AUTH        93015 WHEN                 YES        MRI's &                    NO         FOR AGE            NO               NO     NO
  OPEN ACCESS AUTH OUT & CARE                                                                             EXCEPT                                                                    CADIOLITE     PLAN/CALL GADOLINIUM OVER $
                                WWW.CARECORENATIONAL       DOING                              MRAs                                 40+ COVER
   NEEDED FOR PRI   CORE AUTH                                                                              DEXA                                                                     TEST NEED       AETNA     50.00 BILL # 01513 FOR
                                         .COM         CARDIOLYTE OR                                                                 ONE PER
       AND SEC       PRINT OUT                                                                                                                                                      PRE- CERT     DIRECT 800-      J0152 BILL #00 351
                                                     STRESS THALLIUM                                                                 YEAR
                                                                                                                                                                                    FOR 78465 ,    223-6857     NYMI AS SEC# 01513
                                                                                                                                                                                      78478 &      OPTION 3 APPEALS#0 1458 IF NO             BAYRIDGE OFFICE CAN NOT DO MRI'S . & MRAS
                                                                                                                                                                                       78480.                   PCP SELECTED BILL #          FOR CARECORE // RVC OFFICE CAN NOT SEE
                                                                                                                                                                                                               00351 (make sure to check      ANY PATIENT FOR CARE CORE// PELHAM BAY
                                                                                                                                                                                                                 that pat dont have a pcp    OFFICE IS NOT CREDENTIAL TO PERFORM PET
                                                                                                                                                                                                                         selected)                  SCANS STUDIES FOR CARECORE




                                                                                                                                                                                                                CL#04175(*NYNM) SEC
                                                                                                                                                                                                                 BILL CLAIM CENTER
                                                                                                                                                                                                                   W/OUT *NYNM
                         ELIGIILITY                                             CALL INS &
                                                               DOCTORS
                          MUST BE                                                VERIFY IF                                                                                                          CALL                                      NEED TO CALL UNION AT (212) 334-0096 TO GET
  AFSCME (MULTIPLAN)                                           REFERRAL                         NO          NO           NO             NO             NO               NO     NO      NO
                        VERIFIED BY                                               AUTH                                                                                                            HICKSVILE                                   ELIGIBILITY AND CONFIRM MAILING ADDRESS.
                                                                NEEDED
                           PHONE                                                 NNEDED




                                                                                                                                                                                                                                            ONLY CONTRACTED TO DO CHEST X-RAYS FOR ALLEN
   ALLEN HEALTH CARE                                           DOCTORS
                                                                                                                                                                                                                                             HEALTH CARE SERVICES EMPLOYEE'S . ($25.00 FEE)
        SERVICES                                               REFERRAL                                               CONTRACTED TO DO CHEST X-RAYS ONLY                                                          CLAIM CTR #0 9365
                                                                                                                                                                                                                                            ALLEN HEALTH CARE SERVICES 175-20 HILLSIDE AVE,
    DR. PATTUGALEN                                              NEEDED
                                                                                                                                                                                                                                               2ND FLOOR, JAMAICA NY 11432 (718) 657-2966




6/30/2010                                                                                                             PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                           NPI DOSHI # 1720031339//Page 3
                                                                                                                      Doshi Diagnostic Imaging Services of New York
                                                                                   REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                         REF REQ                                                             AUTHORIZATION REQUIRED

                            INSURANCE WEB                                                                              CT SCAN &                                                                   NUCLEAR
                             SITE PRINT OUT                                                  PET SCAN &                    CT                                                                     MEDICINE &      BREAST
        INSURANCE CO.                                                    REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                          CLAIM CENTER                           COMMENTS
                               ELIGIBILITY                                                     PETCT                  ANGIOGRAPH                                                                   NUCLEAR        BIOPSY
                                  FORM                                                                                     Y                                                  VASCULAR            CARDIOLOGY
                                                WEBSITE ADDRESS                                                                                                               STUDIES      ECHO


                            INSURANCE
                              WEB SITE                                      DOCTORS                                                                                                                                                                   PCP SHOULD GET THE AUTH. AFFINITY REPLACES
                                                                                                          NO, AS OF   NO, AS OF                                                                    NO, AS OF    NO, AS OF
            AFFINITY         PRINT OUT          www.affinityplan.org        REFERRAL            YES
                                                                                                           5/1/04      5/1/04
                                                                                                                                      NO             NO             NO               NO      NO
                                                                                                                                                                                                    5/1/04       5/1/04
                                                                                                                                                                                                                             CLAIM CENTER # 04879     MEDICAID INS . FOR AUTHORIZATION CALL 800-599
                            ELIGIBILITY                                      NEEDED                                                                                                                                                                                    2920 DIAL 82..
                               FORM


                             ELIGIILITY
   AMALGAMATED LIFE                                                         DOCTORS           YES, SEE YES, SEE YES, SEE                                                                                                     CLAIM CENTER # 08902
                              MUST BE                                                                                                                                                                                                                 CALL ALICARE FOR PRE CERTIFICATION AT 1-800 332
    /GROUP WSH-MP                                                           REFERRAL         COMMENT COMMENT COMMENT                  NO             NO             NO               NO      NO       NO           NO        (*NYNM) MULTIPLAN
                            VERIFIED BY                                                                                                                                                                                                                                    5426
        ONLY                                                                 NEEDED              S        S        S                                                                                                              NETWORK
                               PHONE


   AMERICA HEALTH                                                                             NEED TO                                                                                                            NEED TO                             FOR GEHA CALL (800) 821-6136 TO FIND OUT IF THE PT
                     ELIGIILITY
     PLAN (UNITED                                                           DOCTORS          CALL INS &                                                                                                         CALL INS &    PRI - BILL W/(*NYNM)      IS RESPONSIBLE FOR ANY DED/CO-INSURANCE
                      MUST BE
   PAYORS & UNITED                                                          REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO      NO       NO         VERIFY IF     SEC-BILL CLAIM CTR          AMOUNT AND CO-PAYMENT. IF MEMBER
                    VERIFIED BY
  PROVIDER*PPO GEHA                                                          NEEDED            AUTH                                                                                                               AUTH           W/OUT (*NYNM)                 RESPONSIBLE, COLLECT MONEY.
                       PHONE
     (UP & UP)LOGO                                                                            NEEDED                                                                                                             NEEDED                              OTHER PLANS CALL PHONE # ON BACK OF THE CARD.


                            INSURANCE
     AMERICHOICE
                              WEB SITE                                      DOCTORS
    PERSONAL CARE                             http://www.americhoice.c                                                                                                                                                        PRI/SEC & CONTRAST
                             PRINT OUT                                      REFERRAL            NO           NO          NO           NO             NO             NO               NO      NO       NO           NO                                               no auth is needed//
  PLUS         (MHS
                            ELIGIBILITY                  om                  NEEDED
                                                                                                                                                                                                                               MATERIAL #0 9311
    MEDICARE PLAN)
                               FORM


                            INSURANCE
      AMERICHOICE
                              WEB SITE                                      DOCTORS
       (AKS MHS)                              http://www.americhoice.c                                                                                                                                                        PRI/SEC & CONTRAST
    MEDICAID & CHILD
                             PRINT OUT
                                                         om
                                                                            REFERRAL            NO           NO          NO           NO             NO             NO               NO      NO       NO           NO
                                                                                                                                                                                                                               MATERIAL #04655                     no auth is needed
                            ELIGIBILITY                                      NEEDED
    HEALTH PLUS PLAN
                               FORM


                            INSURANCE
        AMERICHOICE
                              WEB SITE                                      DOCTORS
         (AKS MHS)                            http://www.americhoice.c                                                                                                                                                        PRI/SEC & CONTRAST
          POS PLAN
                             PRINT OUT
                                                         om
                                                                            REFERRAL            NO           NO          NO           NO             NO             NO               NO      NO       NO           NO
                                                                                                                                                                                                                               MATERIAL # 09120                    no auth is needed
                            ELIGIBILITY                                      NEEDED
       (COMMERCIAL)
                               FORM

                                                                           AMERIGROUP
                                                                                                                                                                                                  YES, FROM
                                                                            INSURANCE                                                                                                                                         PLAN 09531 (*NYNM)
                            INSURANCE                                                       YES,        YES,        YES,                                                                          AMERIGRO
                                                                             REFERRAL                                                                                                                                        FOR PET SCAN # 04923
       AMERIGROUP             WEB SITE                                                     FROM        FROM        FROM                                                                           UP 800-454-                                          FOR ELIG AND AUTH CALL # 800-454-3730 ( AS OF
                                                                         NEEDED , EXCEPT                                                                                                                                      (DOSHI BILL DIRECT)
    COMMUNITY CARE           PRINT OUT                                                   AMERIGRO AMERIGRO AMERIGRO                   NO             NO             NO               NO      NO    3730 FOR        NO                                    3/1/07 CARE PLUS CHANGED THEIR NAME TO
                                                                           FOR MAMMOS                                                                                                                                            P.O BOX 61020
     /AKA CARE PLUS         ELIGIBILITY                                                  UP 800-454- UP 800-454- UP 800-454-                                                                       NUCLEAR                                                              AMERIGROUP
                                                                         AND THE STUDIES                                                                                                                                      VIRGINIA BEACH, VA
                               FORM                                                         3730        3730        3730                                                                          CARDIOLOG
                                                                          THAT REQ PRE-                                                                                                                                            23466-1020
                                                                                                                                                                                                    Y ONLY
                                                                          CERTIFICATION


     AMERIHEALTH             ELIGIILITY                                                                                                                                                                                                                   FOR BENEFITS CALL 800-492-2385 , FOR PRE-
                                                                            DOCTORS           YES, SEE YES, SEE YES, SEE                                                                                     YES, SEE
   ADMINSTRATOR 720           MUST BE                                                                                                                                                              YES, SEE                                          CERTIFICATION CALL 800-9523404 . AUTHORIZATION IS
                                                                            REFERRAL         COMMENT COMMENT COMMENT                  NO             NO             NO               NO      NO             COMMENT                   9254
      BLAIR MILL            VERIFIED BY                                                                                                                                                           COMMENTS                                               NEEDED AND MAY VARY BY TPA EMPLOYER
                                                                             NEEDED              S        S        S                                                                                            S
   ROAD,HORSHAM PA             PHONE                                                                                                                                                                                                                         PROGRAMS. (SPONSOR-CONTRACTS)

                                                                                                                                                                                                                 NEED TO
                             ELIGIILITY
                                                                            DOCTORS                                                                                                                             CALL INS &
    AMERIHEALTH HMO           MUST BE                                                                                                                                                                                         BILL LOCAL BCBS #00        FOR ADREESS AMERIHEALTH P.O BOX 41574,
                                                                            REFERRAL            YES         YES          YES          NO             NO             NO               NO      NO       NO         VERIFY IF
      (DIV OF BCBS)         VERIFIED BY                                                                                                                                                                                               938                       PHILADELPHIA, PA 19101
                                                                             NEEDED                                                                                                                               AUTH
                               PHONE
                                                                                                                                                                                                                 NEEDED


                      ELIGIILITY                                            CLAIM FORM                                                          YES, ONLY                                                                                             WE NEED AUTH FOR ANY TEST OVER $200.00 ALSO A
  AMERICAN MEDICAL                                                                                                                                         YES , IF                                                           PRI BILL (09034 *NYNM)
                       MUST BE                                            NEEDED FOR ALL                                                           FOR                                                                                                  AMLI CLAIM FORM IS NEEDED FOR ALL TESTS.
  AND LIFE INSURANCE                                                                            YES         YES          YES         YES                  ITS OVER                   YES    YES      YES           YES            SEC BILL -03324
                     VERIFIED BY                                         TESTS OTHERWISE                                                         DIGITAL                                                                                             FOR AUTH, ELIGIBILITY VERIFICATION CALL 80-422-
         (AMLI)                                                                                                                                            $200.00                                                           (MULTIPLAN NETWORK)
                        PHONE                                              INS WON'T PAY                                                        MAMMOS                                                                                                            2002 OR (516) 822-8980

                                                                                              NEED TO                                                                                                            NEED TO        BILL #04172 FOR
                     ELIGIILITY
   ANTHEM HEALTH OF                                                         DOCTORS          CALL INS &                                                                                                         CALL INS &   P.O BOX 424 N. HAVEN
                      MUST BE                                                                                                                                                                                                                                       1)CALL FOR ELIGIBILITY
     NEW YORK (ALL                                                          REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO      NO       NO         VERIFY IF   CT 06473 OR ADDRESS
                    VERIFIED BY                                                                                                                                                                                                                                        2) NO CO PAY
        PLANS)                                                               NEEDED            AUTH                                                                                                               AUTH        ON THE INS CARD IF
                       PHONE
                                                                                              NEEDED                                                                                                             NEEDED           DIFFERENT

                                                                                              NEED TO                                                                                                            NEED TO
                             ELIGIILITY
      ANTHEM HEALTH                                                         DOCTORS          CALL INS &                                                                                                         CALL INS &
                              MUST BE
     PPO (One Health Plan                                                   REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO      NO       NO         VERIFY IF       CLAIM #04303
                            VERIFIED BY
            logo)                                                            NEEDED            AUTH                                                                                                               AUTH
                               PHONE
                                                                                              NEEDED                                                                                                             NEEDED



6/30/2010                                                                                                                          PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                        NPI DOSHI # 1720031339//Page 4
                                                                                                             Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                                    AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                        CT SCAN &                                                                      NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                       CT                                                                        MEDICINE &       BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                  MRA & MRI                       SONO          MAMMO          X-RAYS                                                          CLAIM CENTER                             COMMENTS
                           ELIGIBILITY                                            PETCT                     ANGIOGRAPH                                                                      NUCLEAR         BIOPSY
                              FORM                                                                               Y                                                      VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                               STUDIES     ECHO



  ANTHEM BLUE CROSS                                                                                                                                                                         YES, ONLY
                      ELIGIILITY
     & BLUE SHIELD                                             DOCTORS          YES, THRU YES, THRU YES, THRU                                                                               NUCLEAR
                       MUST BE
  (CONNECTICUT) BLUE                                           REFERRAL         NIA 888-864- NIA 888-864- NIA 888-              NO             NO             NO               NO     NO   CARDIOLOG         NO            CLAIM # 00938
                     VERIFIED BY
   CARE MEMBERS(ALL                                             NEEDED             7237         7237      864-7237                                                                         Y THRU NIA
                        PHONE
        PLANS)                                                                                                                                                                             888-864-7237



                                                                                                                                                                                                                          PRI -CIGNA - BILL
                                                                                                                                                                                             NUCLEAR                                               EFF JANUARY 1, 2007 ALL CLAIMS WHEN BILLING AS
                    ELIGIILITY                                                                                                                                                                                                   30076
                                                                                  YES, ALL    YES, ALL MRI's YES, ALL CT &                                                                 CARDIOLOG                                              PRIMARY - NEEDS TO GO TO CIGNA* IF BILLING AS
                     MUST BE                                   DOCTORS            PET'S BY     & MRAs BY        CTA ,BY                                                                                                      (P.O BOX 5909
  APWU HEALTH PLAN                                                                                                                                                                           Y ONLY                                                 SECONDARY INSURANCE BILL TO APWU DIRECT*
                   VERIFIED BY                                 REFERRAL         CALLING MED CALLING MED CALLING MED             NO              NO             NO              NO     NO                     NO         SCRANTON PA 18505)
   (SEE COMMENTS)                                                               SOLUTIONS 1- SOLUTIONS 1- SOLUTIONS 1-                                                                      THRU MED                                            FOR AUTHORIZATIONS CALL MED SOLUTIONS AT 1-888- 693-
                   PHONE 800-                                   NEEDED                                                                                                                                                 SEC - APWU BILL 00039    3295 OR 3211 FOR PRIM COVERAGE /// AUTH IS NOT NEEDED
                                                                                 888-693-3298  888-693-3298   888-693-3298                                                                 SOLUTIONS
                     222-2798                                                                                                                                                                                            (P.O BOX 1358 GLEN             WHEN APWU IS SECONDARY TO MEDICARE*
                                                                                                                                                                                           888-693-3298
                                                                                                                                                                                                                             BURNEY MD*



     ATLANTIC BUS
                                                               DOCTORS
   EXPRESS 107 Lawson
    Blvd,Oceanside NY
                                                               REFERRAL                    CONTRACTED TO DO CHEST X-RAYS PA & PA/LATERAL /HEWLETT OFFICE                                                                       30057
                                                                NEEDED
          11572


                                                                                                                                                                                                                                                  FOR SCREENING MAMMO: UNDER 39 YEARS OLD
                                                                                                                              ONLY OB                                                                                                            /NEED LOMN 35-39 CAN HAVE A SINGLE BASELINE
                         ELIGIILITY                                                                                            SONO-                                                                                                            DURING AGE PERIOD 40-49 ONCE EVERY 2 YEARS
                                                               DOCTORS                                                                                                                     YES,   ALL
     ATLANTIS HEALTH      MUST BE                                                                                            76805 ANY                                                                                  # 0 8897 ( DON'T SENT           AGE 50+ YR OLD ONCE EVERY YEAR
                                                               REFERRAL             YES           YES            YES                           NO             NO               NO     NO    NUCLEAR          YES
      PLAN HMO/POS      VERIFIED BY                                                                                          AFTER THE                                                                                 CLAIMS TO MULTIPLAN)     FOR DIAGNOSTIC MAMMO(76091-76090) AS MEDICAL
                                                                NEEDED                                                       THIRD ONE                                                      MEDICINE
                           PHONE                                                                                                                                                                                                                    NECESSARY**NEED DR'S PRESCRIPTION FOR
                                                                                                                               DONE                                                                                                             AUTHORIZATION CALL MED SOLUTIONS 1-888-693-
                                                                                                                                                                                                                                                      3295 APWU TELEPHONE# 800- 270-9072



                                                               DOCTORS
    ATLANTIS IMAGING                                                                                                                                                                                                    CLAIM CENTER WC#         FOR ATLANTIS IMAGING OF NY ATTACH DR# 32244
                                                               REFERRAL                             CONTRACTED TO DO MRI'S, CT'S & X-RAYS ONLY*FOR * WORKER COMP PATIENTS
         OF NY                                                                                                                                                                                                                00260               212- 714 2469 AS REF DR # 2. PHONE 973-451-9543
                                                                NEEDED



      BALDWIN UNION                                            DOCTORS
                                                                                                                                                                                                                                                BALDWIN UNION FREE SCHOOL DISTRIC /960 HASTING
       FREE SCHOOL                                             REFERRAL                                   CONTRACTED TO DO CHEST X-RAYS PA & PA/LATERAL /HEWLETT OFFICE                                                        30058
                                                                                                                                                                                                                                                            STREET, BALDWIN NY
         DISTRICT                                               NEEDED



                                                                                                                                                                                            CALL FOR
                                                                                               CALL FOR       CALL FOR                                                                         ALL
   BEECH STREET LOGO                                                             NEED TO     MRA'S &    CT'S, FOR                                                                           NUCLEAR    NEED TO
                      ELIGIILITY
      (WEB SITE IS                                              DOCTOR          CALL INS & MRI'S TO    DEXA TEST
                                                                                                                                                                                             MED TO CALL INS &
                       MUST BE                                                             FIND OUT IF  TO SEE IF                                                                                                         BILL ADDRESS ON
   WWW.BEECHSTREET.                                            REFERRAL          VERIFY IF                                      NO             NO             NO               NO     NO   FIND OUT IF VERIFY IF                                     DDIS IS PAT OF BEECH STREET NETWORK
                     VERIFIED BY                                                            WE NEED      AUTH IS                                                                                                         INSURANCE CARD
       COM NEED                                                 NEEDED            AUTH      PRE-CERT/   NEEDED/                                                                             WE NEED     AUTH
                        PHONE
    EMPLOYER'S NAME                                                              NEEDED PHONE # ON PHONE # ON                                                                               PRE-CERT/  NEEDED
                                                                                               PAT'S CARD    PAT'S CARD                                                                    PHONE # ON
                                                                                                                                                                                           PAT'S CARD



                                                                                 NEED TO
                         ELIGIILITY
                                                               DOCTORS          CALL INS &
      BENCHMARKS OF       MUST BE
                                                               REFERRAL          VERIFY IF                                                     CONTRACTED TO DO MRI 'S                                                 CLAIM CENTER # 04110
       AMERICA CORP     VERIFIED BY
                                                                NEEDED            AUTH
                           PHONE
                                                                                 NEEDED


                                                                                 NEED TO                                                                                                                   NEED TO
                         ELIGIILITY                                                                                                                                                                                                             WE PARTICIPATE WITH BETTER HEALTH ADVANTAGE.
                                                               DOCTORS          CALL INS &                                                                                                                CALL INS &      CLAIM CTR: BILL
      BETTER HEALTH       MUST BE                                                                                                                                                                                                               CALL THE NUMBER ON THE BACK OF THE PAT's CARD
                                                               REFERRAL          VERIFY IF         NO            NO             NO             NO             NO               NO     NO       NO          VERIFY IF       ADDRESS ON
      ADVANTAGE PPO     VERIFIED BY                                                                                                                                                                                                             TO CONFIRM ELIGIBILITY . DO NOT CONFUSE BETTER
                                                                NEEDED            AUTH                                                                                                                      AUTH         INSURANCE CARD
                           PHONE                                                                                                                                                                                                                     HEALTH ADV. WITH BETTER HEALTH PLAN
                                                                                 NEEDED                                                                                                                    NEEDED

                                                                                 NEED TO                                                                          NEED TO
                         ELIGIILITY                                                                          BRICKLA          BRICKLA BRICKLA
                                                              BRICKLAYER        CALL INS & BRICKLAY BRICKLAY         BRICKLAY                 BRICKLAY BRICKLAYE CALL INS &
       BRICKLAYERS        MUST BE                                                                              YER              YER     YER                                 CLAIM# 05873 (We bill the
                                                              CLAIM FORM         VERIFY IF ER CLAIM ER CLAIM         ER CLAIM                 ER CLAIM  R CLAIM   VERIFY IF                                                                                   CLAIM FORM IS NEEDED
       WELFARE FUND     VERIFIED BY                                                                           CLAIM            CLAIM   CLAIM                                      Ins Direct-)
                                                                NEEDED            AUTH       FORM     FORM             FORM                     FORM     FORM      AUTH
                           PHONE                                                                              FORM             FORM    FORM
                                                                                 NEEDED     NEEDED   NEEDED           NEEDED                   NEEDED   NEEDED    NEEDED
                                                                                                             NEEDED           NEEDED NEEDED




6/30/2010                                                                                                                    PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                           NPI DOSHI # 1720031339//Page 5
                                                                                                                          Doshi Diagnostic Imaging Services of New York
                                                                                       REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                             REF REQ                                                             AUTHORIZATION REQUIRED

                              INSURANCE WEB                                                                                CT SCAN &                                                                  NUCLEAR
                               SITE PRINT OUT                                                    PET SCAN &                    CT                                                                    MEDICINE &      BREAST
        INSURANCE CO.                                                        REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                        CLAIM CENTER                           COMMENTS
                                 ELIGIBILITY                                                       PETCT                  ANGIOGRAPH                                                                  NUCLEAR        BIOPSY
                                    FORM                                                                                       Y                                                  VASCULAR           CARDIOLOGY
                                                  WEBSITE ADDRESS                                                                                                                 STUDIES     ECHO

                                                                                                  NEED TO                                                                                                           NEED TO         MEDICAID &
     BROWNSVILLE       ELIGIILITY
                                                                                                 CALL INS &                                                                                                        CALL INS &   UNINSURED PAT BILL         BROWNSVILLE COMMUNITY DEVELOPMENT
   COMMUNITY DEV.       MUST BE
                                                                              BMS REFERRAL        VERIFY IF      NO          NO           NO             NO             NO               NO     NO      NO          VERIFY IF    CLAIM CTR # 08528      CORPORATION 592 ROCKAWAY AVE,BROOKLYN ,NY
  CORP          (BMS) VERIFIED BY
                                                                                                   AUTH                                                                                                              AUTH        PRIV PAT BILL INS                 11212-5539 718 345-5000
       MEDICAID          PHONE
                                                                                                  NEEDED                                                                                                            NEEDED            DIRECT

                                                                                                  NEED TO                                                                                                           NEED TO
                               ELIGIILITY
                                                                                 DOCTOR          CALL INS &                                                                                                        CALL INS &
                                MUST BE
  CAMBRIDGE           PPO**                                                     REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO      NO          VERIFY IF SEE ADDRESS ON CARD
                              VERIFIED BY
                                                                                 NEEDED            AUTH                                                                                                              AUTH
                                 PHONE
                                                                                                  NEEDED                                                                                                            NEEDED

                                                                                                                                                                                                                                                          AUTHORIZATION LETTER IS REQUIRED FOR ALL
                                                                                                                                                                                                                                                           PROCEDURES. THEY WILL REFFER AND MAKE
                                                                                                                           CARE IQ      CARE IQ  CARE IQ CARE IQ                   CARE IQ CARE IQ
                                                                                                          CARE IQ                                                                                     CARE IQ                                          APPOINTMENT FOR PATIENT AND PROVIDE ADVANCE
                                                                               CARE IQ AUTH                                 AUTH         AUTH     AUTH      AUTH                    AUTH     AUTH
                                                                                                           AUTH                                                                                        AUTH     NEED TO                                 AUTHORIZATION BEFORE THE TEST IS PERFORMED.
                               ELIGIILITY                                     LETTER NEEDED                               LETTER,EN    LETTER,E LETTER,EN LETTER,E                LETTER,E LETTER,E
                                                                                                CALL    LETTER,EN                                                                                   LETTER,ENT CALL INS &                                 MAKE SURE TO CALL 1-800-414-4674 TO OBTAIN
                                MUST BE                                       ,BILL ANCICARE                               TER INF     NTER INF TER INF NTER INF                  NTER INF NTER INF                                 PRIV # 05288
            CARE IQ                                                                           HICKSVILL TER INF ON                                                                                   ER INF ON VERIFY IF                                 AUTHORIZATION NUMBER. MOST OF THE CARE IQ
                              VERIFIED BY                                    ,DO NOT BILL PAT                              ON THE       ON THE   ON THE    ON THE                  ON THE   ON THE                                  WC # 09816
                                                                                                  E      THE VISIT                                                                                   THE VISIT   AUTH                                  REFERRED PATIENTS WILL BE WORKERS COMP. ENTER
                                 PHONE                                        MEDICAL OR WC                                 VISIT         VISIT   VISIT     VISIT                    VISIT   VISIT
                                                                                                        SCREEN)N                                                                                    SCREEN)NO NEEDED                                               INF ON THE VIST SCREEN.
                                                                                INSURANCE                                 SCREEN)N     SCREEN) SCREEN)N SCREEN)                   SCREEN) SCREEN)N
                                                                                                           OTES                                                                                         TES                                              FAX MEDICAL REPORT WITHIN (24) HOURS AFTER
                                                                                                                            OTES         NOTES    OTES     NOTES                    NOTES    OTES
                                                                                                                                                                                                                                                        SERVICES HAVE BEEN RENDERED.         (FAX #) 954-
                                                                                                                                                                                                                                                                           441-6350


      CASTLE SENIOR                                                              DOCTOR
     LIVING AT FOREST                                                           REFERRAL                                                CONTRACTED TO DO CHEST X-RAY ONLY                                                           CLAIM# 03064           CASTLE SENIOR LIVING PHONE # 718 760 4600
           HILLS                                                                 NEEDED

                                                                                                              NO, AS OF          AUTH IS
                                                                                                               1/1/2006          REQ. FOR
                                                                                                              NO AUTH            ANY OB
                                                                                                                                  SONO                                                                                                                  CALL FOR AUTH 212 293-9200 OR 800-545-0571 AS OF
                               ELIGIILITY                                                                         IS    AUTH US                                                                       NO, AS OF
                                                                                 DOCTOR                                         AFTER THE                                                                                                              2/1/07 PRIOR AUTH IS NOT REQ FOR THE PERFORMANCE
                                MUST BE                                                                        NEEDED REQ ONLY                                                                       1/1/2006 NO   YES,AUTH       CLAIM CTR # 00189
        CENTER CARE                                                             REFERRAL            YES                          3rd ONE/                NO             NO               NO     NO                                                       OF UP TO THREE MATERNITY ULTRASOUNDS.. PROR
                              VERIFIED BY                                                                     FOR MRIS FOR CTA MUST CALL                                                               AUTH IS      IS REQ.          W(NYNM)*
                                                                                 NEEDED                                                                                                                                                                    AUTH WILL BE REQ. FOR THE PERFORMANCE OF
                                 PHONE                                                                        OR MRAS, STUDIES   CENTER                                                                NEEDED
                                                                                                                                                                                                                                                           ADDITIONAL ULTRASOUND (I.E FOUR OR MORE).
                                                                                                                 SEE               /SEE
                                                                                                              COOMENT           COMMENT
                                                                                                                   S                 S

                              INSURANCE
                                                                                                                                                                                                                                                     PRE-CERTIFICATION IS NEEDED WHEN BACK OF THE
         CIGNA                  WEB SITE                                        DOCTORS           YES,SEE YES,SEE YES,SEE
                                                http://cignaforhcp.cigna.c                                                                                                                            YES,SEE                   CK. BACK OF THE CARD  CARD SHOWS : PRECERTIFICATION NEEDED FOR
   PPO,EPO,INDEMNITY           PRINT OUT                                        REFERRAL         COMMENT COMMENT COMMENT                  NO             NO             NO               NO     NO                    NO
     & CHOICE FUND            ELIGIBILITY                   om                   NEEDED              S       S       S
                                                                                                                                                                                                     COMMENTS                   FOR MAILING ADDRESS OUTPATIENT PROCEDURES ( CALL TEL# LISTED IN THE
                                                                                                                                                                                                                                                                   BACK OF THE CARD.
                                 FORM


         CIGNA
  AMERICAN IMAGING                                                                                                                                                                                    NUCLEAR
         MAGT                                                                                                                                                                                        CARDIOLOG
                                                                                                                                                                                                                                                         AMERICAN IMAGING IS NOT CONTRACTED WITH
  HMO,NETWORK, POS,                                                                                                                                                                                    Y ONLY
                              INSURANCE                                                                                                                                                                         NEED TO         CLAIM CENTER # 02436       CIGNA FOR CARDIOLOGY STUDIES . FOR THE
   HMO OPEN ACCESS                                                                                                                                                                                     (STRESS
                                WEB SITE                                         DOCTOR                       YES, ALL                                                                                         CALL INS &        FOR CARDIOLOGY         FOLLOWING PROCEDURES BILL CIGNA DIRECT (FOR
    ,NETWORK OPEN                               www.americanimaging.n           REFERRAL            YES        MRI's &
                                                                                                                          YES, ALL
                                                                                                                                          NO             NO             NO               NO     NO
                                                                                                                                                                                                        TEST &
                                                                                                                                                                                                                                TESTS BILL ADDRESS      ADRESS, SEE BACK OF THE CARD) 93307,93320,93325,
                               PRINT OUT                                                                                                                                                                        VERIFY IF
   ACCESS, POS OPEN                                      et                                                                 CT's                                                                     CARDIOLYT
                              ELIGIBILITY                                        NEEDED                        MRAs                                                                                              AUTH             ON THE CARD SEE      93015, 93224 & 93000.      FOR AUTHORIZATION CALL
     ACCESS, OPEN                                                                                                                                                                                        E&
                                 FORM                                                                                                                                                                           NEEDED              COMMENTS                      800-859-5288 // AMI WEB SITE IS:
      ACCESS PLUS                                                                                                                                                                                     CARDIAC
                                                                                                                                                                                                                                                                 WWW.AMERICANIMAGING.NET **
   (AUTHORIZATION                                                                                                                                                                                    POOL IMAG
  NEEDED FOR PRI AND                                                                                                                                                                                       )
         SEC)


                                                                                                                                                                                                                                                       CORPORATE HEALTH HAS MANY DIFFERENT
                                                                                                  NEED TO                                                                                                           NEED TO                         CONTRACTS. MOST OF THEM REQUIRE AUTH. SOME
                               ELIGIILITY
                                                                                DOCTORS          CALL INS &   YES, ALL                                                                                             CALL INS &                      DON’T. WE MUST CALL INS. TO GET AUTH # AND IF THE
   CORPORATE HEALTH             MUST BE                                                                                   YES, ALL                                                                                            FOR CLAIM CENTER SEE
                                                                                REFERRAL          VERIFY IF    MRI's &                    NO             NO             NO               NO     NO      NO          VERIFY IF                       REP. SAYS THAT YOU DON’T NEED AUTH FOR THIS
    ADMINISTRATOR             VERIFIED BY                                                                                   CT's                                                                                               BACK OF THE CARD.
                                                                                 NEEDED            AUTH        MRAs                                                                                                  AUTH                           PAT. TAKE THE NAME OF THE REP AND ENTER IT IN
                                 PHONE
                                                                                                  NEEDED                                                                                                            NEEDED                         THE PAT.A/C IN COMMENT FIELD. AND THE TIME. FOR
                                                                                                                                                                                                                                                                AUTH CALL 1(800) 648 4092


                                                                                                                                                                                                                                                         CALL INSURANCE COMPANY (TO FIND OUT IF THE
                                                                                                                                                                                                                    NEED TO
                               ELIGIILITY                                                                                                                                                                                                                    MEMBER IS RESPONSIBLE FOR ANY CO-
   CONSUMER HEALTH                                                              DOCTORS            CALL                                                                                                            CALL INS &      PRI- W(*NYNM)
                                MUST BE                                                                                                                                                                                                                   INSURANCE,COPAYMENT OR DEDUCTIBLE). IF
      NETWORK                                                                   REFERRAL         HICKSVILL       NO          NO           NO             NO             NO               NO     NO      NO          VERIFY IF    SEC-BILL CLAIM CTR
                              VERIFIED BY                                                                                                                                                                                                                 MEMBER RESPONSIBLE , PLEASE COLLECT THE
      CHN LOGO                                                                   NEEDED              E                                                                                                               AUTH          W/OUT (*NYNM)
                                 PHONE                                                                                                                                                                                                                  MONEY. WE NEED COPY OF THE INS CARD BACK &
                                                                                                                                                                                                                    NEEDED
                                                                                                                                                                                                                                                                  FRONT TO BILL THE INS CO.

  CHS NY MEDICAL PC                                                             DOCTORS
      (NY STOCK                                                                 REFERRAL                                                CONTRACTED TO DO CHEST X-RAY ONLY                                                       CLAIM CENTER# 08158
      EXCHANGE)                                                                  NEEDED

6/30/2010                                                                                                                              PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                      NPI DOSHI # 1720031339//Page 6
                                                                                                          Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                              AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                      CT SCAN &                                                                     NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                     CT                                                                       MEDICINE &     BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                   SONO          MAMMO          X-RAYS                                                          CLAIM CENTER                             COMMENTS
                           ELIGIBILITY                                            PETCT                   ANGIOGRAPH                                                                     NUCLEAR       BIOPSY
                              FORM                                                                             Y                                                  VASCULAR              CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                         STUDIES     ECHO

                                                                                 NEED TO                                                                                                              NEED TO
                         ELIGIILITY
    COMMUNITY CARE                                             DOCTORS          CALL INS &                                                                                                           CALL INS &     PRI- W(*NYNM)
                          MUST BE
       NETWORK                                                 REFERRAL          VERIFY IF      NO           NO           NO             NO             NO               NO      NO        NO         VERIFY IF   SEC-BILL CLAIM CTR
                        VERIFIED BY
      (CCN LOGO)                                                NEEDED            AUTH                                                                                                                 AUTH         W/OUT (*NYNM)
                           PHONE
                                                                                 NEEDED                                                                                                               NEEDED

   COMMUNITY CHOICE   ELIGIILITY
                                                               DOCTORS
     HEALTH** WE DO    MUST BE
                                                               REFERRAL                                    WE DO NOT PARTICIPATE WITH THIS INSURACE
    NOT PARTICIPATE* VERIFIED BY
                                                                NEEDED
      UT CODE IS "KC:   PHONE

                                                                                                                                                                                                                                       RIGHT NOW ONLY PELHAM BAY,WOODLAWN,CENTRAL
                                                                                 NEED TO                                                                                                              NEED TO
                         ELIGIILITY                                                                                                                                                                                                       PARK, FORDHAM, HARLEM & WASHINGTON HTS
        COMMUNITY                                              DOCTORS          CALL INS &   YES, ALL                                                                                                CALL INS &
                          MUST BE                                                                                                                                                                                                       LOCATIONS ARE PARTICIPATING WITH COMMUNITY
       PREMIER PLUS                                            REFERRAL          VERIFY IF    MRI's &        NO           NO             NO             NO               NO      NO        NO         VERIFY IF   CLAIM CENTER # 05129
                        VERIFIED BY                                                                                                                                                                                                     PREMIER PLUS, /// INSURANCE COVERAGE ON UT IS
     *SEE COMMENTS *                                            NEEDED            AUTH        MRAs,                                                                                                    AUTH
                           PHONE                                                                                                                                                                                                          """ KA*****HMO // INS WILL BE CLOSING 6/30/07
                                                                                 NEEDED                                                                                                               NEEDED
                                                                                                                                                                                                                                                   **NETWORK TERMINATING*


                         ELIGIILITY                                                                                                                                                                                                         WE ARE PROVIDER OF CCM./// CCM WILL MAKE THE
     COMPREHENSIVE
                          MUST BE                            CCM REFERRAL                                                                                                                                                                  APPOITMENT FOR ALL THEIR PATIENTS.. (DO NOT BILL
         CARE                                                                      NO           NO           NO           NO             NO             NO               NO      NO        NO           NO            CLAIM# 30070
                        VERIFIED BY                            NEEDED                                                                                                                                                                      MEDICARE OR MEDICAID WHEN CCM IS REFFERRING
    MANAGEMENT/CCN
                           PHONE                                                                                                                                                                                                                       THE PATIENT TO DOSHI)


                         ELIGIILITY                                                                                                                                                                                                          FOR DR. ROBERT BLACK, DR JOSE ACEVEDO, DR
                                                                DOCTOR
        CONTINENTAL       MUST BE                                                                                                                                                                                                              MICHAEL NEELY, DR BERRY KRASNER BILL
                                                               REFERRAL                                     CONTRACTED TO DO MRI, CTS AND XRAYS ONLY/TABLE TIME                                                   CONTINENTAL# 08862
         MEDICAL PC     VERIFIED BY                                                                                                                                                                                                        CONTINENTAL ///////// FOR DR KENNETH JAMESON, DR
                                                                NEEDED
                           PHONE                                                                                                                                                                                                                MARK LEVISON BILL METRO MEDICAL…

                         ELIGIILITY
                                                                DOCTOR
                          MUST BE                                                                                                                                                                                 PLAN #01025 ( P.O BOX            CORESOURCE-AETNA SIGNATURE
        CORESOURCE                                             REFERRAL            NO           NO           NO           NO             NO             NO               NO      NO        NO           NO
                        VERIFIED BY                                                                                                                                                                               2920, CLINTO IA 52733)               ADMINISTRATORS*PPO
                                                                NEEDED
                           PHONE

                                                                                 NEED TO                                                                                                              NEED TO
                     ELIGIILITY
   CROSSROAD HEALTH                                             DOCTOR          CALL INS &                                                                                                           CALL INS &
                      MUST BE                                                                                                                                                                                                              DO NOT SEND CLAIMS TO MULTIPLAN (*NYNM) DDIS
      CARE MGTM                                                REFERRAL          VERIFY IF      NO           NO           NO             NO             NO               NO      NO        NO         VERIFY IF       CLAIM # 09547
                    VERIFIED BY                                                                                                                                                                                                                IS PARTICIPATING DIRECT WITH VISTA PLAN.
       LOCAL 812                                                NEEDED            AUTH                                                                                                                 AUTH
                       PHONE
                                                                                 NEEDED                                                                                                               NEEDED

  DIRECTORS GUILD OF ELIGIILITY
                                                                DOCTOR
  AMERICA-PRODUCER    MUST BE                                                                                                                                                                                      PRI 09279 (*NYNM)
                                                               REFERRAL            NO           NO           NO           NO             NO             NO               NO      NO        NO           NO                                     877-866-2200 THE ID# IS THE SUSCRIBER SS#
   HEALTH PLAN(DGA) VERIFIED BY                                                                                                                                                                                       //SEC -30068
                                                                NEEDED
        PHCS           PHONE

  DR. WILLIAM KASUMI                                            DOCTOR
                                                                                CONTRACTED TO DO ULTRASOUNF OF ABDOMEN,THYROID, PELVIS,TRANSVAGINAL AND MAMO, UPPER GI-SERIES,
     41ST MEDICAL                                              REFERRAL                                                                                                                                                   00516
                                                                                                                 MRI'S PELVIS AND CHEST X-RAY
        CENTER                                                  NEEDED


                                                                                                                                                                                                                                            CALL INSURANCE COMPANY (TO FIND OUT IF THE
                                                                                 NEED TO                                                                                                              NEED TO
                         ELIGIILITY                                                                                                                                                                                                             MEMBER IS RESPONSIBLE FOR ANY CO-
                                                                DOCTOR          CALL INS &                                                                                                           CALL INS &     PRI- W(*NYNM)
                          MUST BE                                                                                                                                                                                                            INSURANCE,COPAYMENT OR DEDUCTIBLE). IF
            DEVON                                              REFERRAL          VERIFY IF      NO           NO           NO             NO             NO               NO      NO        NO         VERIFY IF   SEC-BILL CLAIM CTR
                        VERIFIED BY                                                                                                                                                                                                          MEMBER RESPONSIBLE ,PLEASE COLLECT THE
                                                                NEEDED            AUTH                                                                                                                 AUTH         W/OUT (*NYNM)
                           PHONE                                                                                                                                                                                                           MONEY. WE NEED COPY OF THE INS CARD BACK &
                                                                                 NEEDED                                                                                                               NEEDED
                                                                                                                                                                                                                                                     FRONT TO BILL THE INS CO.


                                                                             NEED TO                                                                                                                  NEED TO
                         ELIGIILITY                                                                                                                                                                                                        FOR ALL DISC IMAGING SERVICES PATIENTS ATTACH
                                                                            CALL INS &         AUTH         AUTH        AUTH           AUTH           AUTH          AUTH       AUTH       AUTH       CALL INS &
        DISC IMAGING      MUST BE                             DISC IMAGING                                                                                                                                                                      DR# 24655 AS REF DR #2. DISC IMAGING
                                                                             VERIFY IF        LETTER       LETTER      LETTER         LETTER         LETTER        LETTER     LETTER     LETTER       VERIFY IF        WC #09881
          SERVICES      VERIFIED BY                         SERVICES LETTER                                                                                                                                                                 COORDINATOR WILL SCHEDULE ALL APPOITMENTS
                                                                              AUTH            NEEDED       NEEDED      NEEDED         NEEDED         NEEDED        NEEDED     NEEDED     NEEDED        AUTH
                           PHONE                                                                                                                                                                                                                 AND FAX THE CONFIRMATION LETTER.
                                                                             NEEDED                                                                                                                   NEEDED


                                                                                                                        NO,SEE                       NO,SEE        NO,SEE
                                                                                                                                                                               NO,SEE
                                                                                   NO,SEE       NO,SEE       NO,SEE    COMMEN          NO,SEE       COMMEN        COMMEN                                NO,SEE
                                                                                                                                                                              COMMEN       NO,SEE
                                                                                COMMENT      COMMENT      COMMENT       TS FOR      COMMENT          TS FOR        TS FOR                             COMMENT                           .. ELDERPLAN INSURANCE CARD REPLACES
       ELDER PLAN /   ELIGIILITY                                                                                                                                              TS FOR CO- COMMENTS
                                                                                 S FOR CO-    S FOR CO-    S FOR CO-      CO-        S FOR CO-         CO-           CO-                               S FOR CO-                    MEDICARE. PT WILL BE RESPONSIBLE FOR 20% MCR
       COLLECT SEC     MUST BE                                                                                                                                                INSURAN      FOR CO-
                                                                DOCTOR          INSURANC     INSURANC     INSURANC     INSURAN      INSURANC        INSURAN       INSURAN                             INSURANC PRI/SEC & CONTRANST FEE SCHEDULE FOR MRI/ CT/ PET SCAN , PAT WILL BE
        INSURANCE    VERIFIED BY                                                                                                                                                  CE     INSURANCE
                                                               REFERRAL              E            E            E          CE             E             CE            CE                                    E     MATERIAL # CLAIM  BILL FOR THE 20% ,UNLESS THEY HAVE A SECONDARY
   INFORMATION **SEE PHONE 718-                                                                                                                                               INFORMA INFORMATI
                                                                NEEDED          INFORMAT     INFORMAT     INFORMAT     INFORMA      INFORMAT        INFORMA       INFORMA                            INFORMATI         #04533      INSURANCE /MEDICAID,.. .OR OTHER SEC ///     FOR
     COMMENTS** NO     921-7889                                                                                                                                               TION/20%     ON/20%
                                                                                  ION/20%      ION/20%      ION/20%    TION/20%       ION/20%       TION/20%      TION/20%                              ON/20%                      MEDICAL CLAIMS CALL 718- 921-7889 PASSWORD:
      COPAY NEEDED    OPTION 1                                                                                                                                                 MCR FEE     MCR FEE
                                                                                 MCR FEE      MCR FEE      MCR FEE      MCR FEE      MCR FEE         MCR FEE       MCR FEE                             MCR FEE                              41400///  NO COPAY IS NEEDED ***
                                                                                                                                                                              SCHEDUL SCHEDULE
                                                                                SCHEDULE     SCHEDULE     SCHEDULE     SCHEDUL      SCHEDULE        SCHEDUL       SCHEDUL                             SCHEDULE
                                                                                                                                                                                   E
                                                                                                                           E                            E             E




6/30/2010                                                                                                              PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                          NPI DOSHI # 1720031339//Page 7
                                                                                                            Doshi Diagnostic Imaging Services of New York
                                                                         REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                               REF REQ                                                             AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                        CT SCAN &                                                                  NUCLEAR
                         SITE PRINT OUT                                            PET SCAN &                    CT                                                                    MEDICINE &     BREAST
        INSURANCE CO.                                          REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                      CLAIM CENTER                         COMMENTS
                           ELIGIBILITY                                               PETCT                  ANGIOGRAPH                                                                  NUCLEAR       BIOPSY
                              FORM                                                                               Y                                                  VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                           STUDIES     ECHO


                                                                                                                                                                                                                                     EVERCARE IS A UNITED HEALTH CARE PRODUCT FOR
                                                                                    NEED TO                                                                                                          NEED TO                          MEDICARE BENEFICIARIES WHO RESIDE IN A LONG
                         ELIGIILITY
         EVERCARE                                                  DOCTOR          CALL INS &                                                                                                       CALL INS &                        TERM CARE FACILITY(NURSING HOME) ,COVERED
                          MUST BE
      (DIV. OF UNITED                                             REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO       NO        VERIFY IF   CLAIM CTR # 05382    MEMBERS WILL BE ASSIGNED A PCP . THE PRIMARY
                        VERIFIED BY
       HEALTH CARE)                                                NEEDED            AUTH                                                                                                             AUTH                           PHYS OR NURSE PRACTITIONER MAKE APPT AND GET
                           PHONE
                                                                                    NEEDED                                                                                                           NEEDED                          ANY EVERCARE APPROVAL. ANY QUESTION ON THIS
                                                                                                                                                                                                                                                  PLAN CALL 800-842-2478



                                                                                                                                                                                                      AUTH                          USE THIS CLAIM CENTER ONLY FOR EMPIRE BC/BS FOR
                        INSURANCE                                                   NEED TO
                                                                                                                                                                                                     NEEDED                         OUT STATE FOR E.G PENSYLVANYA, NJ, CONNECTICUT
       EMPIRE (BC/BS)     WEB SITE                                 DOCTOR          CALL INS &                                                                                                                PRI-00938         SEC-
                                                                                                                                                                                                    DEPENDIN                               ETC…. ******************************
      (OUT STATE) SEE    PRINT OUT                                REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO       NO                   BILL ADDRESS ON
                                                                                                                                                                                                      G ON                            WE DO NOT PARTICIPATE WITH BCBS OF GEORGIA
        COMMENTS        ELIGIBILITY                                NEEDED            AUTH                                                                                                                      INSURANCE CARD.
                                                                                                                                                                                                    MEMBERS                          HMO PLAN. PREFIX IS XKH, DO NOT TAKE PATIENTS
                           FORM                                                     NEEDED
                                                                                                                                                                                                      PLAN                                            IN***********


                        INSURANCE             FOR ELIG                                                                                                                                               NEED TO
        EMPIRE
                          WEB SITE                                 DOCTOR                                                                                                                           CALL INS &
     HEALTHCHOICE                         www.empireblue.com
                         PRINT OUT                                REFERRAL            YES          NO          NO           NO             NO             NO               NO     NO       NO        VERIFY IF        # 00399                     ID # START WITH R0000001
   FEDERAL EMPLOYEE
                        ELIGIBILITY
                                             FOR AUTH              NEEDED                                                                                                                             AUTH
      GOV'T WIDE                          WWW.RADMD.COM
                           FORM                                                                                                                                                                      NEEDED

                                                                                                YES, ALL                                                                               AS OF 3/1/05
                                                                                                         YES, AS OF
                        INSURANCE             FOR ELIG                                           MRI's &                                                                                  AUTH      NEED TO
           EMPIRE                                                                                        3/1/05 CT'S
                          WEB SITE                                 DOCTOR                          MRAs                                                                                 NEEDED CALL INS &
       HEALTHCHOICE                       www.empireblue.com                                                 /SEE                                                                                                BILL LOCAL DIRECT   FOR PRE-CERTIFICATION CALL # ON THE BACK OF THE
                         PRINT OUT                                REFERRAL            YES         (AUTH                     NO             NO             NO               NO     NO       FOR      VERIFY IF
         PREFIX FBC
                        ELIGIBILITY
                                             FOR AUTH              NEEDED                        NEEDED
                                                                                                         COMMENT
                                                                                                                                                                                        NUCLEAR      AUTH
                                                                                                                                                                                                                    CLAIM # 00513                         CARD
        (LOCAL 381)                       WWW.RADMD.COM                                                     S FOR
                           FORM                                                                 WHEN PRI                                                                               CARDIOLOG NEEDED
                                                                                                           DEXA
                                                                                                 OR SEC)                                                                                    Y


                                                                                                                                                                                                                                      FOR PRE-CERTIFICATION CALL 1800 982-8951.OR 800-
                                                                                                YES, ALL                                                                               AS OF 3/1/05
                                                                                                                                                                                                      AUTH                            395-7792 OR TELEPHONE # ON BACK OF THE INS CARD
         EMPIRE         INSURANCE             FOR ELIG                                           MRI's & YES/ ALSO                                                                        AUTH
                                                                                                                                                                                                     NEEDED                            (ALICARE) ROUTINE MAMMOGRAM CAN BE DONE
     HEALTHCHOICE         WEB SITE                                 DOCTOR                          MRAs     SEE                                                                         NEEDED
                                          www.empireblue.com                                                                                                                                        DEPENDIN                         ONLY ONCE A YEAR.      CT BONE DENSITY AND DEXA
    DEDICATED SVCES      PRINT OUT                                REFERRAL            YES         (AUTH  COMMENT            NO             NO             NO               NO     NO       FOR                        # 03025
   CENTERS (PREFIXES)   ELIGIBILITY
                                             FOR AUTH              NEEDED                       NEEDED     S FOR                                                                        NUCLEAR
                                                                                                                                                                                                      G ON                           STUDIES CAN BE DONE EVERY TWO YEARS, CALL INS
                                          WWW.RADMD.COM                                                                                                                                             MEMBERS                                     TO CONFIRM DATE OF LAST TEST .
          UNT,             FORM                                                                  FOR PRI   DEXA                                                                        CARDIOLOG
                                                                                                                                                                                                      PLAN                           GO TO BCBS WEB SITE TO CHECK ELEG. AND AUTH ***
                                                                                                AND SEC)                                                                                    Y
                                                                                                                                                                                                                                                      www.empireblue.com



                                                                                                                                                                                                                                   FOR PRE-CERTIFICATION CALL 1800 982-8951.OR 800-
         EMPIRE                                                                                 YES, ALL                                                                               AS OF 3/1/05
                                                                                                                                                                                                      AUTH                         395-7792 OR TELEPHONE # ON BACK OF THE INS CARD
    HEALTHCHOICE        INSURANCE             FOR ELIG                                           MRI's &                                                                                  AUTH                 FOR P.O BOX 3993
                                                                                                         YES/ ALSO                                                                                   NEEDED                         (ALICARE) ROUTINE MAMMOGRAM CAN BE DONE
   DEDICATED SVCES        WEB SITE                                 DOCTOR                          MRAs                                                                                 NEEDED               NY,NY 1008 USE CLAIM
                                          www.empireblue.com                                                SEE                                                                                     DEPENDIN                      ONLY ONCE A YEAR.      CT BONE DENSITY AND DEXA
  CENTERS DIFERENT       PRINT OUT                                REFERRAL            YES         (AUTH                     NO             NO             NO               NO     NO       FOR                  CTR# 08804 OR
  PREFIXES EXAMPLE::    ELIGIBILITY
                                             FOR AUTH              NEEDED                       NEEDED
                                                                                                         COMMENT
                                                                                                                                                                                        NUCLEAR
                                                                                                                                                                                                      G ON
                                                                                                                                                                                                             ADDRESS ON THE CARD
                                                                                                                                                                                                                                  STUDIES CAN BE DONE EVERY TWO YEARS, CALL INS
                                          WWW.RADMD.COM                                                   S DEXA                                                                                    MEMBERS                                  TO CONFIRM DATE OF LAST TEST .
   ACT, SEU, ODE,ODU,      FORM                                                                  FOR PRI                                                                               CARDIOLOG               IF DIFFERENT) **
                                                                                                                                                                                                      PLAN                        GO TO BCBS WEB SITE TO CHECK ELEG. AND AUTH ***
      UMA, TEC ….                                                                               AND SEC)                                                                                    Y
                                                                                                                                                                                                                                                   www.empireblue.com


                                                                                                                                                                                                                                         YLM PREFIX IS A MEDICARE SUPPLEMENT *IS
                                                                                                                                                                                                                                     ALWAYS SEC TO MEDICARE** YLA CAN BE PRI OR SEC
                                                                                                                                                                                       AS OF 3/1/05    AUTH                               OR HOSPITAL COVERAGE ONLY. FOR PRE-
                                                                                                ONLY FOR YES, AS OF
        EMPIRE          INSURANCE             FOR ELIG                                                                                                                                    AUTH       NEEDED                          CERTIFICATION CALL 1800 982-8089OR 800-992-2583 OR
                                                                                                INDEMNIT 3/1/05 CT'S
     HEALTHCHOICE         WEB SITE                                 DOCTOR                                                                                                               NEEDED      DEPENDIN                          TELEPHONE # ON BACK OF THE INS CARD (ALICARE)
                                          www.empireblue.com                                      Y PLAN     /SEE
  TRADITIONAL PLUS &     PRINT OUT                                REFERRAL            YES                                   NO             NO             NO               NO     NO       FOR      G ON WHAT         # 08806        ROUTINE MAMMOGRAM CAN BE DONE ONLY ONCE A
    INDEMNITY PLAN      ELIGIBILITY
                                             FOR AUTH              NEEDED
                                                                                                 FOR ALL COMMENT
                                                                                                                                                                                        NUCLEAR      TYPE OF                          YEAR. AND DEXA STUDIES CAN BE DONE EVERY
                                          WWW.RADMD.COM                                          MRA'S &    S FOR
   PREFIX YLA & YLM        FORM                                                                                                                                                        CARDIOLOG INDEMNIT                              TWO YEARS, CALL INS TO CONFIRM DATE OF LAST
                                                                                                   MRI'S   DEXA
                                                                                                                                                                                            Y         Y PLAN                           TEST .                            GO TO BCBS
                                                                                                                                                                                                                                          WEB SITE TO CHECK ELEG. AND AUTH ***
                                                                                                                                                                                                                                                    www.empireblue.com

          EMPIRE
    HEALTHCHOICE --                                                                                                                                                                                                                  AUTHORIZATION IS NEEDED FOR MEDIBLUE CALL NIA
                        INSURANCE             FOR ELIG
    MEDIBLUE PLAN (                                                                                                                                                                     YES ONLY                                     AT 888-899-7803 OR NUMBER LISTED ON THE BACK OF
                          WEB SITE                                 DOCTOR                       YES, ALL
      SENIOR PLAN                         www.empireblue.com                                                                                                                           CARDIOLYT    CALL                               THE MEMBER'S ID CARD . ROUTINE MAMMOGRAM
                         PRINT OUT                                REFERRAL            YES        MRI's &       YES          NO             NO             NO               NO     NO                                  # 08805
   CHANGED ITS NAME
                        ELIGIBILITY
                                             FOR AUTH              NEEDED                        MRAs
                                                                                                                                                                                       E & STRESS HICKSVILE                          CAN BE DONE ONCE A YEAR AND DEXA TEST CAN BE
  TO MEDIBLUE * AS OF                     WWW.RADMD.COM                                                                                                                                THALLIUM                                       DONE EVERY TWO YEARS, CALL BCBS AND CONFIRM
                           FORM
    1/1/07 ** **YLR**                                                                                                                                                                                                                DATE OF LAST TEST. BCBS ELIG PHONE# 800-441-2411
          PREFIX




6/30/2010                                                                                                                PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                  NPI DOSHI # 1720031339//Page 8
                                                                                                              Doshi Diagnostic Imaging Services of New York
                                                                           REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                 REF REQ                                                             AUTHORIZATION REQUIRED

                          INSURANCE WEB                                                                        CT SCAN &                                                                  NUCLEAR
                           SITE PRINT OUT                                            PET SCAN &                    CT                                                                    MEDICINE &   BREAST
        INSURANCE CO.                                            REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                     CLAIM CENTER                             COMMENTS
                             ELIGIBILITY                                               PETCT                  ANGIOGRAPH                                                                  NUCLEAR     BIOPSY
                                FORM                                                                               Y                                                  VASCULAR           CARDIOLOGY
                                            WEBSITE ADDRESS                                                                                                           STUDIES     ECHO


     EMPIRE HEALTH
  CHOICE          HMO                                                                                                                                                                                  AUTH
                                                                                                                                        SCREENIN
       PRODUCTS                                                                                                                                                                                      NEEDED
                                                                                                                                            G
     HMO -YLN*YLT                                                                                                                                                                         YES ONLY DEPENDIN                              AS OF 11/1/03 AUTHORIZATION IS NEEDED FO ALL HMO
                      INSURANCE                                                                                                         (ROUTINE)
      DIRECT HMO -                              FOR ELIG                                                                                                                                 CARDIOLYT     G ON                               PRODUCTS// FOR AUTH CALL NIA AT 888-899-7803 OR
                        WEB SITE                                     DOCTOR                       YES, ALL                               MAMMO
        YLN*YLT                             www.empireblue.com                                                                                                                           E & STRESS MEMBERS                               NUMBER LISTED ON THE BACK OF THE MEMBER'S ID
                       PRINT OUT                                    REFERRAL           YES         MRI's &       YES          NO           NOT              NO               NO     NO                                  #08803
    DIRECT PAYHMO-                             FOR AUTH                                                                                                                                  THALLIUM , PLAN/CALL                             CARD . ROUTINE MAMMOGRAM CAN BE DONE ONCE
                      ELIGIBILITY                                    NEEDED                        MRAs                                   COVER
        YLN*YLT                             WWW.RADMD.COM                                                                                                                                EXCEPT YLF- 800-552-                             A YEAR AND DEXA TEST CAN BE DONE EVERY TWO
                         FORM                                                                                                            UNDER 34
    DIRECT POS - YLF                                                                                                                                                                      32BJ PLAN  6630 FOR                            YEARS, CALL BCBS AND CONFIRM DATE OF LAST TEST.
                                                                                                                                          YRS OF
  DIRECT HMO/POS-YLN                                                                                                                                                                                   HMO
                                                                                                                                           AGE
   CHILD H. PLUS -YLN                                                                                                                                                                                 PLANS
    HEALTHY NY-YLN


                                                                                                                                        SCREENIN
                                                                                                                                                                                                                                          FOR PRE-CERTIFICATION CALL 1800 982-8089 //800-992-
                                                                                                                                            G
                                                                                                                AUTH                                                                                 AUTH                                2583 OR NIA 888-899-7803 OR NUMBER LISTED ON THE
                          INSURANCE                                                                                                     (ROUTINE)
                                                                                                               NEEDED                                                                     YES ONLY  NEEDED                                    BACK OF THE MEMBER'S ID CARD. ROUTINE
     EMPIRE HEALTH          WEB SITE                                DOCTOR'S                      YES, ALL                               MAMMO                                                                    CLAIM # 08803 - P.O
                                                                                                              DEPENDIN                                                                   CARDIOLYT DEPENDIN                                MAMMOGRAM CAN BE DONE ONLY ONCE A YEAR.
     CHOICE EPO, PPO       PRINT OUT            FOR ELIG            REFERRAL           YES         MRI's &                    NO           NOT              NO               NO     NO                            BOX 1407/ CHURCH
                                            www.empireblue.com                                                  G ON                                                                     E & STRESS  G ON                                DEXA STUDY CAN BE DONE EVERY TWO YEARS, CALL
    YLB, YLD, YLE,YLK,    ELIGIBILITY                                NEEDED                        MRAs                                   COVER                                                                  STREET, NY,NY 10008
                                               FOR AUTH                                                       MEMBERS                                                                    THALLIUM MEMBERS                                       INS TO CONFIRM DATE OF LAST TEST .
                             FORM                                                                                                        UNDER 34
                                            WWW.RADMD.COM                                                       PLAN                                                                                 PLAN                                GO TO BCBS WEB SITE TO CHECK ELEG. AND AUTH ***
                                                                                                                                          YRS OF
                                                                                                                                                                                                                                                          www.empireblue.com
                                                                                                                                           AGE

                                                                                                                AUTH                                                                       AUTH      AUTH
                          INSURANCE
          EMPIRE                                FOR ELIG                                                       NEEDED                                                                     NEEDED    NEEDED
                            WEB SITE                                 DOCTOR                       YES, ALL
       HEALTHCHOICE                         www.empireblue.com                                                DEPENDIN                                                                   DEPENDING DEPENDIN
                           PRINT OUT                                REFERRAL           YES         MRI's &                    NO             NO             NO               NO     NO                                  # 08802                 MAKE SURE THE PREFIX IS AT & T. INS
         ATT PREFIX                            FOR AUTH                                                         G ON                                                                        ON       G ON
                          ELIGIBILITY                                NEEDED                        MRAs
        *HMO & POS*                         WWW.RADMD.COM                                                     MEMBERS                                                                     MEMBERS MEMBERS
                             FORM
                                                                                                                PLAN                                                                       PLAN      PLAN

         EMPIRE                                                                                                 AUTH                                                                       AUTH      AUTH
                          INSURANCE                                                                                                                                                                                                       CALL FOR PRE-CERTIFICATION FOR MRA's & MRI's ,
    HEALTHCHOICE                                FOR ELIG                                                       NEEDED                                                                     NEEDED    NEEDED
                            WEB SITE                                 DOCTOR                       YES, ALL                                                                                                                               USING # ON THE INS. CARD. MAKE SURE THE PREFIX IS
   Merryll Lynch PREFIX                     www.empireblue.com                                                DEPENDIN                                                                   DEPENDING DEPENDIN
                           PRINT OUT                                REFERRAL           YES         MRI's &                    NO             NO             NO               NO     NO                                  # 08801          MLC & MLA . PREFIX MLA HAS A YEARLY DEDUCTIBLE
   MLC, MLA & MLE see                          FOR AUTH                                                         G ON                                                                        ON       G ON
                          ELIGIBILITY                                NEEDED                        MRAs                                                                                                                                   OF $200.00 THEN PAYS 90%. MUST CALL ON EACH
       Comments for                         WWW.RADMD.COM                                                     MEMBERS                                                                     MEMBERS MEMBERS
                             FORM                                                                                                                                                                                                                 PATIENT WHO HAS MLA PREFIX.
      DEDUCTIBLE                                                                                                PLAN                                                                       PLAN      PLAN

                                                                                                                AUTH                                                                       AUTH      AUTH
         EMPIRE           INSURANCE
                                                FOR ELIG                                                       NEEDED                                                                     NEEDED    NEEDED
     HEALTHCHOICE           WEB SITE                                 DOCTOR                       YES, ALL
                                            www.empireblue.com                                                DEPENDIN                                                                   DEPENDING DEPENDIN                               PLEASE, MAKE SURE TO CALL FOR AUTHORIZATION
      NYNEX BELL           PRINT OUT                                REFERRAL           YES         MRI's &                    NO             NO             NO               NO     NO                                  # 08800
                                               FOR AUTH                                                         G ON                                                                        ON       G ON                                    TELEPHONE # SHOWING ON THE PAT'S CARD.
    ATLANTIC      *       ELIGIBILITY                                NEEDED                        MRAs
                                            WWW.RADMD.COM                                                     MEMBERS                                                                     MEMBERS MEMBERS
       NYN PREFIX            FORM
                                                                                                                PLAN                                                                       PLAN      PLAN
                                                                                                                       AUTH IS
                                                                                                                       REQ. FOR                                                                                                           AS OF 3/7/2006 DDIS IS PARTICIPATING WITH FIDELIS
                                                                                                                                                                                           NO AUTH
                                                                                                                       ANY OB                                                                                                             INSURANCE … FOR AUTHORIZATION FOR PET SCAN
                                                                                                                                                                                           NEEDED
                           ELIGIILITY                                                                          AUTH US   SONO                                                                                                             CALL 1-888-343-3547 EXT 2805 / AS OF 1/1/06 FIDELIS
                                                                     DOCTOR                                                                                                              ,,NEED NHP
                            MUST BE                                                                           REQ ONLY AFTER                                                                        YES,AUTH                             REFERRAL IS NOT NEEDED. AUTH WILL BE REQ. FOR
   FIDELIS (ALL PLANS)                                              REFERRAL           YES           NO                                      NO             NO               NO     NO      CLAIM                   CLAIM# 02952
                          VERIFIED BY                                                                          FOR CTA  THE 3rd                                                                      IS REQ.                             ANY OB /MATERNITY SONO PERFORM AFTER THE 3RD
                                                                     NEEDED                                                                                                                  FORM
                             PHONE                                                                             STUDIES   ONE/                                                                                                            ONE //MUST CALL CENTER CARE TO VERIFY LAST OB
                                                                                                                                                                                          SIGNED BY
                                                                                                                         MUST                                                                                                               PERFORMED FOR THE PATIENT.. AT 888-343-3547-
                                                                                                                                                                                           MEMBER
                                                                                                                         CALL                                                                                                                          FOLLOW THE PROMPTS **
                                                                                                                       CENTER
                       ELIGIILITY                                                                                                                                                                                   PRI- BILL 09571
                                                                     DOCTORS                                                                                                                                                            FOR PRECERTIFICATIONS AND ELIGIBILITY, CALL
  FIRST HEALTH * MAIL   MUST BE                                                                                                                                                                                   W(*NYNM) SEC-BILL
                                                                     REFFERAL          YES          YES          YES          NO             NO             NO               NO     NO      YES        NO                             REQ.s AUTH. IF NO AUTH.REQD., THEN PUT THE NAME
       HANDLERS*      VERIFIED BY                                                                                                                                                                               CLAIM CTR W/OUT 04878
                                                                      NEEDED                                                                                                                                                                 OF THE REP IN /NOTES. 1(800) 410-7778
                         PHONE                                                                                                                                                                                         (*NYNM)


                                                                                                                                                                                                                                           FIRST HEALTH HAS SEVERAL TYPE OF PPO PLANS.
                                                                                      NEED TO                                                                                                                                                 THEREFORE FOR PRECERTIFICATIONS AND
                           ELIGIILITY                                                           YES, ALSO
                                                                     DOCTORS         CALL INS &            YES ,SEE YES ,SEE YES ,SEE YES ,SEE YES ,SEE YES ,SEE            YES ,SEE                               PRI- W(*NYNM)         ELIGIBILITY, PLEASE CALL PHONE NUMBER ON BACK
        FIRST HEALTH        MUST BE                                                             MRA's SEE                                                         YES ,SEE
                                                                     REFFERAL         VERIFY IF           COMMENT COMMEN COMMENT COMMEN COMMEN COMMEN                      COMMENT                               SEC-BILL CLAIM CTR       OF CARD FOR EACH PATIENT AND CONFIRM. ASK IF
          NETWORK         VERIFIED BY                                                           COMMENT                                                          COMMENTS
                                                                      NEEDED           AUTH                   S       TS        S       TS       TS       TS                   S                                   W/OUT (*NYNM)           THE PROCEDURE REQ.s AUTH. IF NO AUTH.REQD.,
                             PHONE                                                                  S
                                                                                      NEEDED                                                                                                                                             THEN PUT THE NAME OF THE REP IN /NOTES. FOR PRE-
                                                                                                                                                                                                                                                 CERTIFICATION CALL 1(800) 410-7778


                           ELIGIILITY                                                                                                                                                       YES,
                                                                     DOCTOR                         YES,
                            MUST BE                                                                           YES/ ALL                                                                    NUCLEAR                                        FOR AUTHORIZATIONS , CALL MED SOLUTIONS -1-888-
            GEHA                                                    REFERRAL           YES        ALL MRI's                   NO             NO             NO               NO     NO                 NO        PRI OR SEC ** # 01668
                          VERIFIED BY                                                                           CT's                                                                     CARDIOLOG                                                      693-3295 OR 3211
                                                                     NEEDED                       & MRA's
                             PHONE                                                                                                                                                         Y ONLY

           GENEX /
                           ELIGIILITY                                                            CONTRACTED TO DO MRI'S,CT, BONE SCANS ** MRI W/OUT CONT $400.00                                                                          GENEX-INDEPENDENT REVIEW SVCES WILL CALL
        INDEPENDENT
                            MUST BE                                AUTH LETTER        MRI W/CONTR $500 ** CT W/OUT CONT $275 ** CT W/CONTR $375                 BONE SCANS $160                                                           DOSHI TO SET UP APPOINTMENT FOR THE PAT AND
           REVIEW                                                                                                                                                                                                     WC# 03715
                          VERIFIED BY                            NEEDED FROM IRS                 LIMITED AREA/ $210.00 ** MULTIPLE AREA / $230.00 WHOLE BODY/$240.00                                                                       AUTH LETTER WILL BE FAXED TO OUR FACILITY
         SERVICES,INC
                             PHONE                                                                                       3 PHASES/ $280.00 WITH                                                                                               IND SERVICES TELEPHONE #800 310-39-26
             WC
6/30/2010                                                                                                                  PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                     NPI DOSHI # 1720031339//Page 9
                                                                                                               Doshi Diagnostic Imaging Services of New York
                                                                           REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                 REF REQ                                                              AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                           CT SCAN &                                                                      NUCLEAR
                         SITE PRINT OUT                                               PET SCAN &                    CT                                                                        MEDICINE &      BREAST
        INSURANCE CO.                                             REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                            CLAIM CENTER                             COMMENTS
                           ELIGIBILITY                                                  PETCT                  ANGIOGRAPH                                                                      NUCLEAR        BIOPSY
                              FORM                                                                                  Y                                                  VASCULAR               CARDIOLOGY
                                            WEBSITE ADDRESS                                                                                                            STUDIES      ECHO


                                                                                                                                                                                               YES, ALL
                                                                                                                                                                                              NUCLEAR       YES, AUTH
                                                                                                                                                                                              MEDICINE       NEEDED
                                                                                                                                                                                                                                                        FOR PRE-CERTIFICATION CALL 800-835-7064
                                                                                                                                                                                             NEED PRE-      DEPENDIN
                                                                                                                                           NO, FOR                                                                                                  (AUTHORIZATIONS ARE GOOD FOR ONLY 45 DAYS)
                                                                                                     YES,                                                                                       CERT         G ON THE     PRI********00002
                                                                     DOCTORS                                     YES/                      MAMMO                                                                                                     AUTHORIZATION VARY BY PLAN, CATEGORY OR
                                                                                         YES       ALL MRI's                   NO                            NO               NO       NO        FOR        CATEGORY      SEC *******01686
                                                                     REFERAL                                    ALL CT's                    SEE                                                                                                    GROUP NUMBER/ CALL GHI FOR ALL MEMBERS. THE
       G.H.I PPO &                                                                                 & MRA's                                                                                    CADIOLITE       #/CALL    CONTRAST MATERIAL
                                                                                                                                           BELOW                                                                                                    LAST FIVE DIGIT OF THE AUTHORIZATION NUMBER
    HEALTHY NY EPO /                                                                                                                                                                         TEST NEED          GHI         BILL ***03797
                                                                                                                                                                                                                                                       HAS TO MATCH THE PROCEDURE CODE TO BE
       UNITE HERE     INSURANCE              FOR ELIGIBILITY                                                                                                                                  PRE- CERT      DIRECT                               PERFORM. IF WE DO NOT GET AUTHORIZATION OR THE
  (HEALTH PASS PPO &    WEB SITE               www.ghi.com                                                                                                                                   FOR 78465 &    FOR AUTH                               AUTHORIZATION DOES NOT MATCH THE CPT WE WILL
     EPO, BAKERY 550   PRINT OUT                FOR AUTH                                                                                                                                     78478 BOTH,
                                                                                                                                                                                                                                                      NOT GET PAID( WE CAN NOT APPEAL!) GO TO
         FOR GHI-     ELIGIBILITY         WWW.CARECORENATIONAL
                                                                                                                                                                                                                                                  CARECORENATIONAL..COM WEB SITE AND CHECK FOR
     SECONDARY TO        FORM                     .COM
                                                                                                                                                                                                                                                    AUTHORIZATIONS //// FOR GHI ELEGIBYLITY CHECK
  MEDICARE/COLLEC                                                 FOR SCREENING MAMMO CPT( 76092) Under 39 yrs of age need a letter of medical necessity. Age 35-39 can have a single baseline during the age                                      WWW.GHI.COM . (CLAIMS FOR LOCAL 3/ BAKERY GO
  T $50.00 DEDUCTIBLE                                              period, any additional w/timely history mother or sister will need a letter of medical necessity. Age 40-49 once every 2 years during the age period; any                       TO GHI DIRECT) AS OF 1/1/07 HEALTHY NY EPO PLAN
                                                                  additional w/timely history of mother or sister will need a letter of medical necessity. Age 50 + yrs old once every year, any additional will need a letter                       CLAIMS GO TOT HE NY CITY OFFICE// ALSO UNITE
                                                                                                                                       of medical necessity.                                                                                      HERE AND THE BROOKLYN HEALTH WORKS HEALTHY
                                                                                                                                                                                                                                                                     NY PROGRAM.


                                                                 FOR DIAGNOSTIC MAMMO (76091-76090) AS MEDICALLY NECESSARY* GET DR'S PRESCRIPTION STATING REASON FOR MAMMO.


                                                                                                                                                                                                                                                    LOCAL 365 (CATEGORY 4-AP)MEDICAL CLAIMS GO TO
                                                                                        YES,     YES,     YES,
                                                                                                                                                                                                                        FOR COMPREHENSIVE COMPREHENSIVE #8615                       COMBINED WELFARE
                        INSURANCE            FOR ELIGIBILITY                          DEPENDS DEPENDS DEPENDS                                                                                                NEED TO
                                                                                                                                                                                                                        USE CLAIM CENTER# FUND- 81-28 MARGARET PLACE ,GLENDALE NY 11385 #
                          WEB SITE             www.ghi.com                               ON       ON       ON                                                                                               CALL INS &
       GHI -NETWORK                                                  DOCTORS                                                                                                                                            PRI 00002 SEC# 01686         9083 LOCAL 210/GHI THE MAXON COMPANY BILL #
                         PRINT OUT              FOR AUTH                               MEMBER  MEMBER MEMBER                   NO             NO             NO               NO       NO        NO          VERIFY IF
          ACCESS                                                     REFERAL                                                                                                                                           (no longer using the P.O Box   8306 //LOCAL 14-14B BILL # 3570 AUTH IS NEEDED
                        ELIGIBILITY       WWW.CARECORENATIONAL                        PLAN,SEE PLAN,SEE PLAN,SEE                                                                                              AUTH
                                                                                                                                                                                                                       8955, Melville NY Address-    DEPENDING ON THE PLAN.. CALL NUMBER ON THE
                           FORM                   .COM                                COMMENT COMMENT COMMENT                                                                                                NEEDED
                                                                                                                                                                                                                          08615)) as of 1/1/2007     PATIENT CARD..(SINCE THEY HAVE DIFF UNIONS &
                                                                                          S        S        S
                                                                                                                                                                                                                                                                        CONTRACTS)


                                                                                                                            ONLY OB
                                                                                                                             SONO-                                                                                                                  FOR AUTHORIZATION CALL CARECORE AT 800-835-
     GHI -HMO (CHP,     INSURANCE            FOR ELIGIBILITY                                                                 76805                                                                                                                7064 (EFFECTIVE MAY/2000 WITH PARTICIPATE W/GHI
  FHP,MEDICAID PLAN).     WEB SITE             www.ghi.com      NEED GHI HMO                         YES,                     ANY                                                                                                                 HMO SELECt COMMERCIAL PLAN) CHECK FOR AUTH
                                                                                                               YES/ ALL
  COLLECT COPAY FOR      PRINT OUT              FOR AUTH        REFERRAL FOR             YES       ALL MRI's                 AFTER            NO             NO               YES     YES        YES           NO               # 09489                       ON CARECORE WEB SITE::::
                                                                                                                 CT's
    ALL PROCEDURES      ELIGIBILITY       WWW.CARECORENATIONAL ALL 90000'S ONLY.                   & MRA's                    THE                                                                                                                 WWW.CARECORENATIONAL.COM /// AUTHORIZATION
    EXCEPT MAMMO           FORM                   .COM                                                                       THIRD                                                                                                                  IS NEEDED FOR ALL 90000'S SERIES FROM GHI HMO
                                                                                                                              ONE                                                                                                                                      DIRECT .
                                                                                                                             DONE

                        INSURANCE            FOR ELIGIBILITY        DOCTORS
        GHI MEDICARE                                                                                                                                                                                                                               NEED AUTHORIZATION FROM CARE CORE FOR ALL
                          WEB SITE             www.ghi.com           REFERAL                         YES,
         CHOICE PPO                                                                                            YES/ ALL                                                                                                                           MRA'S , ALL MRI's , STRESS TEST & CARDIOLYTE AND
                         PRINT OUT              FOR AUTH          NO COPAY FOR           YES       ALL MRI's                   NO             NO             NO               NO       NO        YES           YES          CLAIM # 0 8462
         (REPLACES                                                                                               CT's                                                                                                                              NUCLEAR MEDICINE . FOR AUTH CALL 800-835-7064
                        ELIGIBILITY       WWW.CARECORENATIONAL       ANNUAL                        & MRA's
         MEDICARE)                                                                                                                                                                                                                                   GHI -MEDICARE PLAN REPLACES MEDICARE.
                           FORM                   .COM             SCREENING

                        INSURANCE                                                      NEED TO
                          WEB SITE                                                    CALL INS &
    G.H.I HEALTH PLAN                                                 DOCTOR
                         PRINT OUT             WWW.GHI.COM                             VERIFY IF      NO          NO           NO             NO             NO               NO       NO        NO            NO               # 02316             DO NOT BILL GHI DIRECT/ BILL CLAIM CTR # 2316
         LOCAL 1-S                                                   REFERRAL
                        ELIGIBILITY                                                     AUTH
                           FORM                                                        NEEDED

                        INSURANCE                                                      NEED TO
                          WEB SITE                                                    CALL INS &
                                                                      DOCTOR
  GHI- BAKERY LOCAL 3    PRINT OUT             WWW.GHI.COM                             VERIFY IF      NO          NO           NO             NO             NO               NO       NO        NO            NO       PRI#00002 SEC# 01686                       CATEGORY 38A
                                                                     REFERRAL
                        ELIGIBILITY                                                     AUTH
                           FORM                                                        NEEDED

                                                                                                                                                           YES,
                                                                                      YES, NEED YES, NEED YES, NEED            YES,   YES, NEED          NEED TO          YES,         YES,                 YES, NEED
                                                                                                                                                                                               YES, NEED
                                                                                       TO CALL   TO CALL   TO CALL          NEED TO TO CALL               CALL         NEED TO      NEED TO                  TO CALL
                                                                                                                                                                                                TO CALL
                        INSURANCE                                                      UHP TO    UHP TO    UHP TO           CALL UHP UHP TO              UHP TO        CALL UHP     CALL UHP                 UHP TO
   GHI-UNITED HEALTH                                                                                                                                                                            UHP TO
                          WEB SITE                                                     VERIFY     VEIFY     VEIFY           TO VEIFY    VEIFY             VEIFY        TO VEIFY     TO VEIFY                  VEIFY
      PLANS * $75.00                                                  DOCTOR                                                                                                                     VEIFY
                         PRINT OUT             WWW.GHI.COM                            WHETHER WHETHER WHETHER               WHETHER WHETHER              WHETHE        WHETHER      WHETHER                 WHETHER          PLAN # 30069                    FOR AUTH CALL 800-445-4206
    COPAY FOR ALL                                                    REFERRAL                                                                                                                  WHETHER
                        ELIGIBILITY                                                    AUTH IS   AUTH IS   AUTH IS           AUTH IS   AUTH IS           R AUTH         AUTH IS      AUTH IS                 AUTH IS
     DIAG TESTING*                                                                                                                                                                              AUTH IS
                           FORM                                                        NEEDED    NEEDED    NEEDED            NEEDED NEEDED                  IS          NEEDED       NEEDED                  NEEDED
                                                                                                                                                                                              NEEDED 800-
                                                                                       800-445-  800-445-  800-445-          800-445-  800-445-          NEEDED         800-445-     800-445-                800-445-
                                                                                                                                                                                                445-4206
                                                                                         4206      4206      4206              4206      4206            800-445-         4206         4206                    4206
                                                                                                                                                           4206


                         ELIGIILITY
                                                                      DOCTOR                         YES,
       GREAT WEST         MUST BE                                                                              YES/ ALL                                                                                                 PRI // SEC # 03370 (MED
                                                                     REFERRAL            YES       ALL MRI's                   NO             NO             NO               NO       NO        NO            NO                                   * FOR AUTH CALL MED SOLUTIONS 1-888- 693- 3295
     (MED SOLUTIONS)    VERIFIED BY                                                                              CT's                                                                                                          SOLUTIONS)
                                                                      NEEDED                       & MRA's
                           PHONE

6/30/2010                                                                                                                   PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                           NPI DOSHI # 1720031339//Page 10
                                                                                                                     Doshi Diagnostic Imaging Services of New York
                                                                               REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                     REF REQ                                                                  AUTHORIZATION REQUIRED

                         INSURANCE WEB                                                                                CT SCAN &                                                                    NUCLEAR
                          SITE PRINT OUT                                                 PET SCAN &                       CT                                                                      MEDICINE &       BREAST
        INSURANCE CO.                                                REFERRAL REQUIRED                  MRA & MRI                     SONO          MAMMO          X-RAYS                                                          CLAIM CENTER                              COMMENTS
                            ELIGIBILITY                                                    PETCT                     ANGIOGRAPH                                                                    NUCLEAR         BIOPSY
                               FORM                                                                                       Y                                                    VASCULAR           CARDIOLOGY
                                             WEBSITE ADDRESS                                                                                                                   STUDIES     ECHO


                                                                                                                                                                                                                                                PLEASE USE THIS CLAIM CENTER ONLY WHEN PHCS
                                                                                                                                                                                                                              PRI-BILL 03607
                                                                                                                                                                                                                                                LOGO IS SHOWING INT HE INSURANCE CARD. IF THE
                                                                                                                                                                                                                              W(*NYNM) IF
                                                                                          NEED TO                                                                                                                                              INSURANCE CARD DOES NOT SHOW PHCS LOGO, BILL
                          ELIGIILITY                                                                                                                                                                                      APPLETOWN ADD// FOR
                                                                         DOCTOR          CALL INS &                                                                                                                                            GUARDIAN INS DIRECT. CALL INSURANCE COMPANY
             GUARDIAN      MUST BE                                                                                                                                                                                CALL     OTHER ADD NEED TO
                                                                        REFERRAL          VERIFY IF         NO           NO            NO             NO             NO               NO     NO       NO                                        (TO FIND OUT IF THE MEMBER IS RESPONSIBLE FOR
            (PHCS)LOGO   VERIFIED BY                                                                                                                                                                            HICKSVILE   CALL & CONFIRM
                                                                         NEEDED            AUTH                                                                                                                                               ANY CO-INSURANCE,COPAYMENT OR DEDUCTIBLE). IF
                            PHONE                                                                                                                                                                                             MALING ADD
                                                                                          NEEDED                                                                                                                                                  MEMBER RESPONSIBLE ,PLEASE COLLECT THE
                                                                                                                                                                                                                           SEC-BILL CLAIM CTR
                                                                                                                                                                                                                                                MONEY. WE NEED COPY OF THE INS CARD BACK &
                                                                                                                                                                                                                             W/OUT (*NYNM)
                                                                                                                                                                                                                                                       FRONT TO BILL THE INSURANCE CO.


                                                                                          NEED TO                                                                                                                NEED TO
                          ELIGIILITY
                                                                         DOCTOR          CALL INS &                                                                                                             CALL INS &
                           MUST BE
        GUARDIAN FC                                                     REFERRAL          VERIFY IF         NO           NO            NO             NO             NO               NO     NO       NO         VERIFY IF
                         VERIFIED BY
                                                                         NEEDED            AUTH                                                                                                                   AUTH
                            PHONE
                                                                                          NEEDED                                                                                                                 NEEDED


                                                                                           NEED TO        NEED TO      NEED TO                                                                      NEED TO      NEED TO
                          ELIGIBILITY
                                                                                         CALL INS &     CALL INS & CALL INS &                                                                      CALL INS &   CALL INS &
                           MUST BE                                        DOCTOR
    HARVARD PILGRIM                                                                       VERIFY IF      VERIFY IF    VERIFY IF                                                                     VERIFY IF    VERIFY IF     PRI#08200 (*NYNM) SEC#
                          VERIFY BY                                      REFERRAL
                                                                                            AUTH           AUTH         AUTH
                                                                                                                                       NO              NO             NO              NO     NO
                                                                                                                                                                                                      AUTH         AUTH                  03625
                                                                                                                                                                                                                                                                        PHCS NETWORK
    PPO (PHCS) LOGO      CALLING 1-708-                                   NEEDED
                                                                                          NEEDED 1-      NEEDED 1-    NEEDED 1-                                                                   NEEDED 1-800- NEEDED 1-
                             4414
                                                                                         800-708-4414   800-708-4414 800-708-4414                                                                    708-4414   800-708-4414

                                                                                          NEED TO                                                                                                                NEED TO
                          ELIGIILITY
      HEALTH CARE                                                        DOCTOR          CALL INS &                                                                                                             CALL INS &                              WHEN THE PATIENT IS OVER 65, CALL WATCHTOWER
                           MUST BE
     SUPPORT AKA AS                                                     REFERRAL          VERIFY IF         NO           NO            NO             NO             NO               NO     NO       NO         VERIFY IF PRIV-04613        NF-04192   TO FIND OUT IF PATIENT HAS MEDICARE******** FOR
                         VERIFIED BY
      WATCHTOWER                                                         NEEDED            AUTH                                                                                                                   AUTH                                     ID USE THE SOCIAL SECURITY #. 800-554 -4022
                            PHONE
                                                                                          NEEDED                                                                                                                 NEEDED

                                                                                                                                  ONLY
                                                                                                                                 THESE                                                              YES,ALL
                                                                                                                                  CPTS                                                             NUCLEAR
                                                                                                                                  76801                                                            MEDICINE-
                         INSURANCE             FOR ELIGIBILITY                                                       YES, ALL                                                                                                                            FOR AUTH CALL CARE CORE AT 1-877-773-6964 , THE
       HEALTH FIRST                                                                                     YES, ALL                  76805                                                               FOR
                           WEB SITE           www.healthfirst2.org       DOCTOR                                        CT'S                                                                                                                             REFERRING DOCTOR IS RESPONSIBLE FOR OBTAINING
      MEDICAID PLAN                                                                      YES, AS OF     MRA'S &                   76811                                                           CARDIOLYT
                          PRINT OUT              FOR AUTH               REFERRAL                                      EXCEPT                          NO             NO               NO     NO                     NO         CLAIM CENTER # 04408     THE PRE CERTIFICATION… FOR GROUP # FIDFHP BILL
          (PHSP)                                                                           8/15/05      MRI'S AS                  76812                                                           E GET AUTH
                         ELIGIBILITY       WWW.CARECORENATIONAL          NEEDED                                      DEXA AS                                                                                                                              FIDELIS INSURANCE** FOR GROUP # CTRFHP BILL
     SEE COMMENTS*                                                                                      OF 8/15/05                76817                                                           FOR /78465-
                            FORM                   .COM                                                              OF 8/15/05                                                                                                                           CENTER CARE INSURANCE/CHECK INS GUIDELINES
                                                                                                                                  76645                                                           78478-78480
                                                                                                                                BEYOND                                                               AS OF
                                                                                                                                 THREE                                                               8/15/05
                                                                                                                                STUDIES*

                                                                                                                                  ONLY
                                                                                                                                 THESE                                                              YES,ALL
                                                                                                                                  CPTS                                                             NUCLEAR
                                                                                                                                  76801                                                           MEDICINE-
                         INSURANCE             FOR ELIGIBILITY                                                       YES, ALL                                                                                                                            FOR AUTH CALL CARE CORE AT 1-877-773-6964 , THE
  HEALTH FIRST EARLY                                                                                    YES, ALL                  76805                                                               FOR
                           WEB SITE           www.healthfirst2.org       DOCTOR                                        CT'S                                                                                                                             REFERRING DOCTOR IS RESPONSIBLE FOR OBTAINING
      START PLAN                                                                         YES, AS OF     MRA'S &                   76811                                                           CARDIOLYT
                          PRINT OUT              FOR AUTH               REFERRAL                                      EXCEPT                          NO             NO               NO     NO                     NO          CLAIM CRT # 02820        THE PRE CERTIFICATION… FOR GROUP FIDFHP BILL
  (CHILD H.PLUS) PLAN                                                                      8/15/05      MRI'S AS                  76812                                                           E GET AUTH
                         ELIGIBILITY       WWW.CARECORENATIONAL          NEEDED                                      DEXA AS                                                                                                                               FIDELIS INSURANCE** FOR GROUP CTRFHP BILL
   * SEE COMMENTS                                                                                       OF 8/15/05                76817                                                            FOR 78465-
                            FORM                   .COM                                                              OF 8/15/05                                                                                                                           CENTER CARE INSURANCE/CHECK INS GUIDELINES
                                                                                                                                  76645                                                           78478-78480
                                                                                                                                BEYOND                                                               AS OF
                                                                                                                                 THREE                                                               8/15/05
                                                                                                                                STUDIES/

                                                                                                                                ONLY                                                                YES,ALL
                                                                                                                                THESE                                                              NUCLEAR
                                                                                                                                CPTS                                                              MEDICINE-
                          INSURANCE
                                              FOR ELIGIBILITY                                                        YES, ALL 76801
                                                                                                        YES, ALL                                                                                      FOR                      Effective immediatley bill AS OF 8/15/05 AUTHORIZATION IS NEEDED FROM CARE
       HEALTH FIRST      WEB SITE PRINT      www.healthfirst2.org        DOCTOR                                        CT'S     76805
                                                                                         YES, AS OF     MRA'S &                                                                                   CARDIOLYT                    plan # 30032 - health first CORE . FOR AUTH CALL CARE CORE AT 1-877-773-6964 ,
       *HEALTHY NY            OUT               FOR AUTH                REFERRAL                                      EXCEPT 76811                    NO             NO               NO     NO                     NO
                          ELIGIBILITY
                                                                                           8/15/05      MRI'S AS                                                                                  E GET AUTH                   Direct /// CLAIM CRT #         THE REFERRING DOCTOR IS RESPONSIBLE FOR
      (SEE COMMENTS                        WWW.CARECORENATIO             NEEDED                                      DEXA AS 76812
                             FORM                                                                       OF 8/15/05                                                                                 FOR 78465-                     08107 MEDFOCUS                   OBTAINING THE PRE CERTIFICATION…
                                                NAL.COM                                                              OF 8/15/05 76817 76645
                                                                                                                                BEYOND                                                            78478-78480
                                                                                                                                THREE                                                                AS OF
                                                                                                                                STUDIES//                                                            8/15/05

                                                                                                                                ONLY
                                                                                                                                THESE                                                               YES,ALL
                                                                                                                                CPTS                                                               NUCLEAR
                                                                                                                                76801                                                             MEDICINE-
                         INSURANCE             FOR ELIGIBILITY                                                       YES, ALL                                                                                                  Effective immediatley AS OF 8/15/05 AUTHORIZATION IS NEEDED FROM CARE
                                                                                                        YES, ALL                76805                                                                 FOR
     HEALTH FIRST 65       WEB SITE           www.healthfirst2.org       DOCTOR                                        CT'S
                                                                                         YES, AS OF     MRA'S &                 76811                                                             CARDIOLYT                       bill plan # 30031     CORE . FOR AUTH CALL CARE CORE AT 1-877-773-6964 ,
          PLUS            PRINT OUT              FOR AUTH               REFERRAL                                      EXCEPT                          NO             NO               NO     NO                     NO
                                                                                           8/15/05      MRI'S AS                76812                                                             E GET AUTH                    health first Direct ///    THE REFERRING DOCTOR IS RESPONSIBLE FOR
     (MEDICARE HMO)      ELIGIBILITY       WWW.CARECORENATIONAL          NEEDED                                      DEXA AS
                                                                                                        OF 8/15/05              76817                                                              FOR 78465-                  MEDFOCUS # 09887                 OBTAINING THE PRE CERTIFICATION…
                            FORM                   .COM                                                              OF 8/15/05
                                                                                                                                76645                                                             78478-78480
                                                                                                                                BEYOND                                                               AS OF
                                                                                                                                THREE                                                                8/15/05
                                                                                                                                STUDIES/


6/30/2010                                                                                                                           PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                          NPI DOSHI # 1720031339//Page 11
                                                                                                                        Doshi Diagnostic Imaging Services of New York
                                                                                    REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                          REF REQ                                                              AUTHORIZATION REQUIRED

                         INSURANCE WEB                                                                                   CT SCAN &                                                                  NUCLEAR
                          SITE PRINT OUT                                                      PET SCAN &                     CT                                                                    MEDICINE &    BREAST
        INSURANCE CO.                                                     REFERRAL REQUIRED                MRA & MRI                   SONO          MAMMO          X-RAYS                                                     CLAIM CENTER                                COMMENTS
                            ELIGIBILITY                                                         PETCT                   ANGIOGRAPH                                                                  NUCLEAR      BIOPSY
                               FORM                                                                                          Y                                                  VASCULAR           CARDIOLOGY
                                             WEBSITE ADDRESS                                                                                                                    STUDIES     ECHO

                                                                                                                                   ONLY
                                                                                                                                   THESE                                                             YES,ALL
                                                                                                                                   CPTS                                                             NUCLEAR
                                                                                                                                   76801                                                           MEDICINE-
                         INSURANCE             FOR ELIGIBILITY                                                          YES, ALL                                                                                           Effective immediatley    FOR AUTH CALL CARE CORE AT 1-877-773-6964 , THE
                                                                                                           YES, ALL                76805                                                               FOR
     HEALTH FIRST          WEB SITE           www.healthfirst2.org            DOCTOR                                      CT'S                                                                                                                     REFERRING DOCTOR IS RESPONSIBLE FOR OBTAINING
                                                                                              YES, AS OF   MRA'S &                 76811                                                           CARDIOLYT              bill plan # 30031 health
    MANAGED HEALTH        PRINT OUT              FOR AUTH                    REFERRAL                                    EXCEPT                        NO             NO               NO     NO                  NO                               THE PRE CERTIFICATION… FOR GROUP # FIDFHP BILL
                                                                                                8/15/05    MRI'S AS                76812                                                           E GET AUTH                   first Direct ///
   COMMERCIAL ONLY       ELIGIBILITY       WWW.CARECORENATIONAL               NEEDED                                    DEXA AS                                                                                                                      FIDELIS INSURANCE** FOR GROUP # CTRFHP BILL
                                                                                                           OF 8/15/05              76817                                                            FOR 78465-             MEDFOCUS # 09887
                            FORM                   .COM                                                                 OF 8/15/05                                                                                                                   CENTER CARE INSURANCE/CHECK INS GUIDELINES
                                                                                                                                   76645                                                           78478-78480
                                                                                                                                   BEYOND                                                             AS OF
                                                                                                                                   THREE                                                              8/15/05
                                                                                                                                   STUDIES/

                                                                                               NEED TO ALL MRA's
                          ELIGIILITY                                                                             YES / ALSO
                                                                              DOCTOR          CALL INS & & MRI's            YES -SEE                                                                YES [SEE                                           . PRE-CERTIFICATIONS ARE REQUIRED / FOR PRE-
    HEALTH NETWORK         MUST BE                                                                                 BONE                                                                                        CALL       BILL ADDRESS ON THE
                                                                             REFERRAL          VERIFY IF   [SEE             COMMEN                     NO             NO               NO     NO   COMMENTS                                           CERTIFCATION CALL 877-387-8503 OR NUMBER ON
       AMERICA           VERIFIED BY                                                                              DENSITY                                                                                    HICKSVILE           CARD
                                                                              NEEDED            AUTH     COMMENT              TS                                                                       ]                                                        THE CARD IF IT IS DIFFERENT
                            PHONE                                                                                 & DEXA
                                                                                               NEEDED        S


                                                                                                                                                                                                                                                          TOUCHTONE IS PROCESSING ALL CLAIMS FOR
                                                                                                                                                                                                                                                         HEALTNET-SMART CHOICE FOR NY ONLY. FOR
      HEALTH NET/PHS                                                                                                                                                                                                                                   AUTHORIZATION CALL TOUCHTONE (866) 323-1693
       (SMART CHOICE)                                                                                                                                                                                                                                 AUTH ARE GOOD FOR 90 DAYS. ***SMART CHOICE
                         INSURANCE                                                                                                                                                                   YES ALL
         AS PRI OR SEC                                                                                                                                                                                                                                  PLAN REPLACES MEDICARE***** SOME PATIENTS
                           WEB SITE                                            DOCTOR                      YES, ALL     YES / ALL                                                                   NUCLEAR                 BILL ID WITH HN #
        (TOUCHTONE)                                                                                                                                                                                                                                       BELONGS TO HERITAGE / APPLY HEALTHCARE
                          PRINT OUT            www.healthnet.com              REFFERAL           YES        MRI's &     CT'S AND        NO             NO             NO               NO    YES   CARDIOLOG      NO      00936 /// FOR OTHER
      (MEDICARE HMO)                                                                                                                                                                                                                                 PARTNES GUIDELINES .. SEE BELOW FOR GUIDELINES .
                         ELIGIBILITY                                           NEEDED                       MRAs         DEXA                                                                       Y , MUGA,               ID'S # BILL 30009
       SEE COMMENTS                                                                                                                                                                                                                                       BUT ONLY IF THE PCP IS PART OF HERITAGE...
                            FORM                                                                                                                                                                        ECG
         FOR DIRECT                                                                                                                                                                                                                                     TOUCHTONE 888-777-0350 OR 888-777 0350 . FOR
         TOUCHTONE                                                                                                                                                                                                                                     TOUCHTONE PAT WITH EXMAPLE OF ID #100001106
                                                                                                                                                                                                                                                      BILL PLAN# 30009 .....AS OF 1/1/06 NO INS REFFERAL IS
                                                                                                                                                                                                                                                                             NEEDED



                                                                                                                                                                                                                                                 HERITAGE PROCESS CLAIMS FOR HEALTHNET -SMART
                                                                                                                                                                                                                                                   CHOICE PLAN-WHEN THE PCP IS PART OF HERITAGE
                                                                                                                                     NO, IF PCP
                                                                                                                                                          YES, IF                YES, IF YES, IF                                                  FIRST , CHECK PCP'S NAME ON HERITAGE CAPITATED
                                                                                             YES, IF  YES, IF  YES, IF               BELONGS YES, IF                                                          YES, IF
                                                                          IF PCP IS PART OF                                                                 PCP                    PCP     PCP   YES, IF PCP                                     LIST, IF THE PCP IS CAP(X), CHECK THE HERITAGE CAP
                                                                                               PCP      PCP      PCP                  TO HCP/      PCP                                                          PCP
                                                                            HEALTHCARE                                                                   BELONGS                BELONGS BELONGS BELONGS                                            REPORT TO SEE IF THE PAT IS LISTED UNDERNEATH
   HEALTHNET -SMART                                                                         BELONGS BELONGS BELONGS                   AUTH IS BELONGS                                                        BELONGS      HCP CAP# 30064(70000
                         INSURANCE                                            PARTNERS/                                                                  TO HCP/                TO HCP/ TO HCP/   TO HCP/                                          THE DOCTOR NAME. IF THE PATIENT IS NOT LISTED
   CHOICE-(MEDICARE-                                                                         TO HCP/  TO HCP/  TO HCP/                  NOT      TO HCP/                                                      TO HCP/     CPTS-NEED TO CHECK
                           WEB SITE        www.healthnet.com /If PCP IS      HERITAGE *                                                                   AUTH IS                AUTH IS AUTH IS  AUTH IS                                         CALL HERITAGE TO FIND OUT IF THE PAT IS PART OF
   HMO) IF PCP IS PART                                                                       AUTH IS  AUTH IS  AUTH IS               NEEDED/ AUTH IS                                                          AUTH IS            PCP ON THE
                          PRINT OUT            PART HERITAGE (               INSURANCE                                                                   NEEDED                 NEEDED NEEDED     NEEDED                                         HERITAGE /IF THEY TELL YOU THAT THE PAT BELONGS
    OF HEALTHCARE                                                                            NEEDED   NEEDED   NEEDED                  NEED      NEEDED                                                       NEEDED       CAPITATED REPORT)
                         ELIGIBILITY          WWW.HCPIPA.COM)                REFFERAL IS                                                                   FROM                   FROM    FROM     FROM                                           TO HERITAGE BILL NON-CAP # 30062 (PROCEDURES
    PARTNERS-AKA -                                                                            FROM     FROM     FROM                   ONLY       FROM                                                         FROM         ///// HCP NON CAP#
                            FORM                                            NEEDED FROM                                                                   HEALTH                 HEALTH HEALTH    HEALTH                                          70000 TO 79999 ARE CAPITATED). (PROCEDURES 90000
       HERITAGE                                                                              HEALTH   HEALTH   HEALTH                 HCP INS    HEALTH                                                       HEALTH      30063(ALL 90000 CPTS )
                                                                            PCP FROM HCP                                                                   CARE                   CARE    CARE     CARE                                             TO 99999 ARE NON CAP,REGARDLESS OF WHETHER
                                                                                              CARE     CARE     CARE                 REFERRA      CARE                                                         CARE
                                                                          FOR ALL STUDIES                                                                PARTNER                PARTNER PARTNER PARTNERS                                               PRIMARY DR IS CAP. . NEED AUTH FOR ALL
                                                                                            PARTNERS PARTNERS PARTNERS                  L IS    PARTNERS                                                     PARTNERS
                                                                                                                                                             S                      S       S                                                    PROCEDURES . IF PCP IS NOT PART OF HERITAGE BILL
                                                                                                                                      NEEDED
                                                                                                                                                                                                                                                      (TOUCHTONE) -SEE ABOVE FOR GUIDELINES)
                                                                                                                                                                                                                                                            HERITAGE PHONE # (516) 746-2200



                                                                                                                                     YES, OB
                                                                                                                                     SONO-                                                                                        70000'S &
                                                                                                                                     76801-                                                                                 A9505,A9500,A4641-         . FOR AUTH CALL CARE CORE AT 866-898 6287 OR
                                                                                                                                     76811                                                                                $50.00 ,A9503 BILL PRI#-       CHECK CARE CORE NATIONAL WEB SITE. THE
                                                                                                                                     ANY                                                           YES, ALL               02679 SEC-02495        *        REFERRING PHYS MUST OBTAIN THE PRE-
                         INSURANCE             FOR ELIGIBILITY                                                                                                                                                                                         CERTIFICATION///// AUTH ARE GOOD FOR 45 DAYS
   HEALTH NET / CARE                                                                                                                 AFTER                                                         NUCLEAR                  APPEALS BILL 03540
                           WEB SITE           www.healthnet.com                                            YES, ALL
  CORE HMO, POS, PPO                                                       DR.'S REFERRAL                                            THE                                                           MEDICINE &             CONTRAST OVER $50.00
                          PRINT OUT              FOR AUTH                                        YES        MRI's &      ALL CT's                       NO             NO              NO     NO                  NO
   EPO (CHARTER) &                                                             NEEDED                                                THIRD                                                         NUCLEAR                      BILL # 02495
                         ELIGIBILITY       WWW.CARECORENATIONAL                                             MRAs
       PEQUOT                                                                                                                        ONE                                                           CARDIOLOG
                            FORM                   .COM
                                                                                                                                     DONE                                                          Y                                                  BAYRIDGE OFFICE CAN NOT DO MRI'S . & MRAS
                                                                                                                                     AND                                                                                   90000 SERIES, J0152 &      FOR CARECORE // RVC OFFICE CAN NOT SEE
                                                                                                                                     76817                                                                                58340 BILL PRI-SEC AS        ANY PATIENT FOR CARE CORE// PELHAM BAY
                                                                                                                                     TRANSV                                                                                OF 5/1/05 BILL # 00512     OFFICE IS NOT CREDENTIAL TO PERFORM PET
                                                                                                                                     OB                                                                                     PRIOR USE # 03146                SCANS STUDIES FOR CARECORE
                                                                                                                                                                                                                                 (*NYNM)

                         INSURANCE
                                                                                                                                                                                                                             as 9/1/04 PRI/SEC #
        HEALTH NET         WEB SITE                                                                                                                                                                                                              AS OF 9/1/04 TRICARE NAME IS HEALTH NET FEDERAL
                                                                             DOCTORS                       YES/ MRI's                                                                                                      04860      TRICARE AS
   FEDERAL SERVICES /     PRINT OUT          WWW.MYTRICARE.COM                                   YES                       NO           NO             NO             NO               NO     NO       NO         NO                             SERVICES, BUT IS NOT PART OF CARE CORE. CALL FOR
                                                                          REFERAL NEEDED                    & MRA's                                                                                                       SEC# 01497 (ONLY MCR
      AKA TRICARE        ELIGIBILITY                                                                                                                                                                                                              AUTHO FOR MRA'S & MRI'S & PET SCAN (877-874-2273
                                                                                                                                                                                                                              SUPPLEMENT )
                            FORM




6/30/2010                                                                                                                            PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                       NPI DOSHI # 1720031339//Page 12
                                                                                                                 Doshi Diagnostic Imaging Services of New York
                                                                            REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                  REF REQ                                                               AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                             CT SCAN &                                                                   NUCLEAR
                         SITE PRINT OUT                                               PET SCAN &                      CT                                                                     MEDICINE &     BREAST
        INSURANCE CO.                                             REFERRAL REQUIRED                 MRA & MRI                   SONO          MAMMO          X-RAYS                                                        CLAIM CENTER                            COMMENTS
                           ELIGIBILITY                                                  PETCT                    ANGIOGRAPH                                                                   NUCLEAR       BIOPSY
                              FORM                                                                                    Y                                                  VASCULAR            CARDIOLOGY
                                           WEBSITE ADDRESS                                                                                                               STUDIES      ECHO




                        INSURANCE                                                      NEED TO                                                                                                             NEED TO
                          WEB SITE                                    DOCTOR          CALL INS &                                                                                                          CALL INS &
         HEALTH-NET
                         PRINT OUT                                   REFERRAL          VERIFY IF       NO           NO           NO             NO             NO               NO      NO      NO         VERIFY IF    CLAIM CTR #0 9313
        SERVICES LTD
                        ELIGIBILITY                                   NEEDED            AUTH                                                                                                                AUTH IS
                           FORM                                                        NEEDED                                                                                                              NEEDED



                                                                                                                               YES, OB
                                                                                                                                 SONO
                                                                                                                                 ONLY
                                                                                                                                (76805-                                                                                                                      FOR AUTHORIZATION
                        INSURANCE
                                                                                                                              76811/768                                                                                                       CALL 718- 630-0123**** PROVIDER # 000424114808 (AS
                          WEB SITE                                    DOCTOR                       YES/ MRI's
                                                                                                                                  01                                                                                       BILL #04073         OF 5/1/05 WE ARE BILLING DIRECT TO H.PLUS ///
        HEALTH PLUS      PRINT OUT        www.healthplus-ny.org      REFERRAL            YES       & MRA's see      NO
                                                                                                                              OBTAININ
                                                                                                                                                NO             NO               NO      NO      NO           NO
                                                                                                                                                                                                                         CONTRAST# 08174      CALL THE AUTO MATED SYSTEM TO CHECK FOR
                        ELIGIBILITY                                   NEEDED                        comments
                                                                                                                                  GA                                                                                                           AUTH# 800-639-6968 make sure that there is auth for
                           FORM
                                                                                                                                THIRD                                                                                                                  EACH PROCEDURE PERFORMED>
                                                                                                                              SONOGRA
                                                                                                                                M) see
                                                                                                                               comments


                                                                      DOCTOR
      HIP DR. AHMED
                                                                                        CONTRACTED TO DO STRESS THALLIUM** NEED AUTH FROM HIP-DIRECT INSURANCE COMPANY …
                                                                                                                                                                                                                         CLAIM CENTER
                                           WWW.HIPUSA.COM            REFERRAL
        PERVAIZ,MD
                                                                      NEEDED
                                                                                                                                                                                                                             08262



                                                                      DOCTOR
       HIP DR. ADAM                                                                                                                                                                                                                            BILLED DR NACHMIAS DIRECT FOR LS AND PELVIS X-
                                                                     REFERRAL                            BILL DR FOR CERVICAL , LUMBAR SPINE AND PELVIS X-RAY ONLY.                                                      CLAIM CTR#04558
        NACHMIAS DC                                                                                                                                                                                                                           RAY ONLY/ FOR OTHER PROCEDURES BILL HIP DIRECT.
                                                                      NEEDED



                                                                     CENTRAL
                                                                    BROOKLYN
   HIP- BEDFORD WEST
                                                                  MEDICAL GROUP
     MED.GROUP 233                                                                                                                                                                                                                            PATIENT WILL BE COMING WITH BROOKLYN CENTRAL
                                            WWW.HIPUSA.COM           REFERRAL            NO            NO           NO           NO             NO             NO               NO      NO      NO           NO        CLAIM CENTER # 09168
     NOSTRAND AVE,                                                                                                                                                                                                                                  REF & WILL HAVE HIP INSURANCE CARD
                                                                  NEEDED EXCEPT
   BROOKLYN NY 11205
                                                                   FOR MAMMO
                                                                    SCREENING




                         ELIGIILITY
                                                                                                                                                                                                                                                       CALL 877- 524-9393 AND GET PRE-
     HIP- CONTINUUM       MUST BE                                   HIP REFERRAL
                                                                                         NO           YES           YES         YES             YES            YES              YES    YES      YES          YES        CLAIM CTR # 08538      CERTIFICATION***FOR ALL TEST. NEED AUTH FROM
    HEALTH PARTNERS     VERIFIED BY                                NEEDED BY PCP
                                                                                                                                                                                                                                                          CONTINUUM H. PARTNERS
                           PHONE




                         ELIGIILITY
          HIP             MUST BE                                   HIP REFERRAL                                                                                                                                                               HIP CARD WILL SHOW THE MONTIFIORE LOGO ON.
                                                                                         NO            NO           NO           NO             NO             NO               NO      NO      NO           NO          CLAIM CTR# 00341
    MONTIFIORE LOGO     VERIFIED BY                                NEEDED BY PCP                                                                                                                                                                        FOR ELEG. CALL 877-447-6668
                           PHONE




6/30/2010                                                                                                                     PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                      NPI DOSHI # 1720031339//Page 13
                                                                                                            Doshi Diagnostic Imaging Services of New York
                                                                        REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                              REF REQ                                                                AUTHORIZATION REQUIRED

                         INSURANCE WEB                                                                       CT SCAN &                                                                     NUCLEAR
                          SITE PRINT OUT                                          PET SCAN &                     CT                                                                       MEDICINE &     BREAST
        INSURANCE CO.                                         REFERRAL REQUIRED                 MRA & MRI                    SONO          MAMMO          X-RAYS                                                         CLAIM CENTER                             COMMENTS
                            ELIGIBILITY                                             PETCT                   ANGIOGRAPH                                                                     NUCLEAR       BIOPSY
                               FORM                                                                              Y                                                    VASCULAR            CARDIOLOGY
                                           WEBSITE ADDRESS                                                                                                            STUDIES      ECHO
    HIP /CARE CORE                                              DOCTOR REF IS                                                                                                              YES, ALL
                                                               NEEDED (NO HIP
        HIP-HMO                                                                                                                                                                           NUCLEAR
                                                                                                                                                         FOR AUTH CALL CARECORE AT 1-888-622-7329* MAKE
                                                               REF IS NEEDED
   HIP-CHILD H.PLUS                                            WHEN PATIENT                                                                                                               MEDICINE
                                                                                                                                                          SURE THAT THE PCP & PT DON'T , HIP CONTINUUM
    HIP-MEDICAID-                                             BELONGS TO CARE                                                                                                             NEED PRE-
                                                                                                                                                          HEALTH PARTNERS, HIP BEDFORD, HIP MONTEFIORE,
  (CHP)          HIP-                                           CORE ),/////HIP                                                                                                               CERT
                                                                                                                                                              AND HERITAGE/ SEE BELOW FOR HERITAGE
                                                                REFERRAL IS                                                                                                 GUIDELINES .
    MEDICARE (VIP)                                               NEEDED FOR                                                     70000,S, 90000 , ISOVUE,                                      FOR
      HIP-CHOICE                                                                           YES, OB                                   ADENOSINE +         ALWAYS CALL HIP TO CONFIRM THE PCP ASSIGNMENT.
                                                                                                                                                                                          CADIOLIT
                                                                BREAST CYST
   HIP-CHOICE PLUS INSURANCE        FOR ELIGIBILITY           ASPIRATIONS AND YES, ALL SONO-76801-                                  A9500,A9505 &                1800- 447-8255 OR CHECK WEB SITE
                                                                                                                                                                                            E TEST
                                                                   YES, ALL  CT's EXCEPT 76805-76811                                                                                                  AUTH IS
  HIP-PRIME HMO-EP WEB SITE         www.hipusa.com             BREAST BIOPSY                                                    CONTRAST UNDER $50. THE VIP PLAN REPLACES MEDICARE INSURANCE & THE
                                                                                                                                                                                          NEED PRE-
                                                                    MRI's &
                                                              FOR ALL PLANS….  DEXA (    ANY AFTER                                                         CHP HEALTH PLAN REPLACES MEDICAID . * DEXA  NOT
                                                                                                                                      BILL #09794                                         CERT FOR NEEDED,
    AUTH NEEDED       PRINT OUT       FOR AUTH               YES  MRAs AND DEXA CAN THE THIRD        NO NO NO NO                                               TEST CAN ONLY BE DONE ONCE A YEAR
                                                                 GADOLLINIU ONLY BE      ONE DONE                                FOR ISOTOPES,AND
    FOR PRI-& SEC     ELIGIBILITY WWW.CARECORENAT                                                                                                                                            78465 , ONLY HIP
                                                                 N INJECTION DONE ONCE AND 76817                                  GADOLINIUM OVER
                         FORM                                                                                                                                                               78478 &    REF
                                   IONAL.COM                                   A YEAR)    TRANSV                                $50.00 BILL #09721 HIP
                                                                                             OB                                   AS SEC BILL # 09721                                        78480.
                                                                                                                                   APPEALS # 09616         BAYRIDGE OFFICE CAN NOT DO MRI'S . & MRAS
                                                                                                                                                           FOR CARECORE // RVC OFFICE CAN NOT SEE
        A)FOR   ALL HIP INSURANCE CARDS WITH OR W/OUT HERITAGE LOGO , ALWAYS CHECK TO SEE IF THE PRIMARY PHYSICIAN AND PATIENT BELONGS TO                   ANY PATIENT FOR CARE CORE// PELHAM BAY
                                                                                                                                                           OFFICE IS NOT CREDENTIAL TO PERFORM PET
                HERITAGE / SEE BELOW FOR HERITAGE GUIDELINES & COMMENTS// B) GO TO CARE CORE WEB SITE AND CHECK FOR AUTH WEB SITE                                 SCANS STUDIES FOR CARECORE
                                                                                         WWW.Carecorenational.com

                                                                                                                                                                                                                                             HERITAGE PROCESS CLAIMS FOR ALL HIP PLANS. FIRST ,
                                                                                                                                                                                                                                         CHECK PCP'S NAME ON HERITAGE CAPITATED LIST, IF THE PCP
   HIP- HEALTH CARE                                                                                                                         YES,                                                                                          IS CAP(X), CHECK THE HERITAGE CAP REPORT TO SEE IF THE
  PARTNERS/HERITAGE                                                                                                                       EXCEPT                                                                                             PAT IS LISTED UNDERNEATH THE DOCTOR NAME. IF THE
        HIP- BASIC       INSURANCE                                                 NEED TO                             NO AUTH           LOWER &                                                       NEED TO                             PATIENT IS NOT LISTED CALL HERITAGE TO FIND OUT IF THE
                                                               INS. REFERRAL                                                   YES, ONLY                                                                                                   PAT IS PART OF HERITAGE /IF THEY TELL YOU THAT THE PAT
         HIP-HMO           WEB SITE                                               CALL INS &    YES, ALL     YES, ALL NEEDED               UPPER                                                       CALL INS &
                                           WWW.HCPIPA.COM &    NEEDED FROM                                                         FOR                                                                               CAP-01563     NON-   BELONGS TO HERITAGE BILL NON-CAP # 1223 . IF THE PCP IS
    HIP-CHILD H.PLUS      PRINT OUT                                                VERIFY IF     MRI's &     CT'S also  ONLY             EXTREMI                             YES    YES      YES       VERIFY IF
                                            WWW.HIPUSA.COM      PCP FOR ALL                                                    DIAGNOST                                                                              CAP*1223 HERITAGE      (O) NON CAP, PLEASE CALL HERITAGE TO SEE IS THE PCP IS
      HIP-MEDICAID       ELIGIBILITY                                                AUTH         MRAs         DEXA     REFERRA              TIES                                                       AUTH IS
                                                                   TESTS ,                                                      IC MAMO                                                                             WEB SITE: HCPIPA.COM STILL PART OF HERITAGE. (PROCEDURES 70000 TO 79999 ARE
   HIP-MEDICARE (VIP)       FORM                                                   NEEDED                                 L              CHEST X                                                       NEEDED                                   CAPITATED). (PROCEDURES 90000 TO 99999 ARE NON
       HIP-CHOICE                                                                                                                           RAY,                                                                                           CAP,REGARDLESS OF WHETHER PRIMARY DR IS CAP. . NEED
    HIP-CHOICE PLUS                                                                                                                        SKULL                                                                                               AUTH FOR ALL PROCEDURES . IF PCP IS NOT PART OF
                                                                                                                                                                                                                                                         HERITAGE BILL (HIP/CARE CORE)
                                                                                                                                                                                                                                                         HERITAGE PHONE # (516) 746-2200


                         INSURANCE
                                                                                                                                                                                           YES, ONLY
                           WEB SITE                             HIP REFERRAL                                                                                                                                                                 BILL HIP DIRECT ONLY WHEN PAT DON’T BELONG TO
                                                                                                                                                                                           NUCLEAR                  CLAIM CENTER # 08622
  HIP-DIRECT              PRINT OUT         WWW.HIPUSA.COM      NEEDED ( SEE         YES          YES           NO            NO             NO             NO               NO      NO              NO                                     CARE CORE .. NEED AUTH FROM HIP INS DIRECT. NOT
                                                                                                                                                                                          CARDIOLOG                   SEE COMMENTS
                         ELIGIBILITY                             COMMENTS)                                                                                                                                                                                     CARE CORE**
                                                                                                                                                                                               Y
                            FORM

                         INSURANCE
                                                                                                                                                                                           YES, ONLY
     HIP-QUEENS LONG       WEB SITE                             HIP REFERRAL                                                                                                                                          BILL CLAIM # 0 8622
                                                                                                                                                                                           NUCLEAR                                           BILL HIP DIRECT ONLY WHEN PAT DON’T BELONG TO
     ISLAND MEDICAL       PRINT OUT         WWW.HIPUSA.COM      NEEDED ( SEE         YES          YES           NO            NO             NO             NO               NO      NO                   NO        (HIP-DIRECT) PRIOR TO
                                                                                                                                                                                          CARDIOLOG                                                            CARE CORE /
         GROUP PTS       ELIGIBILITY                             COMMENTS)                                                                                                                                            05/31/05 USE #08955
                                                                                                                                                                                               Y
                            FORM

                                                                                   NEED TO                                                                                                              NEED TO
                          ELIGIILITY                                                                                                                                                                                  PRI -# 00938 (OUT
       HORIZON BLUE                                              DOCTORS          CALL INS &                                                                                                           CALL INS &
                           MUST BE                                                                                                                                                                                   STATE) SEC- # 01869
       CROSS & BLUE                                              REFERRAL          VERIFY IF      YES           NO            NO             NO             NO               NO      NO      NO         VERIFY IF                             CALL FOR AUTHO FOR MRA'S & MRI'S (800) 664-2583
                         VERIFIED BY                                                                                                                                                                                 ONLY FOR P.O BOX
        SHIELD OF NJ                                              NEEDED            AUTH                                                                                                                 AUTH
                            PHONE                                                                                                                                                                                     1609,NEWARK NJ
                                                                                   NEEDED                                                                                                               NEEDED


                                                                                                                                                                                           YES ONLY
      HORIZON OF NY
                                                                                                                                                                                            STRESS                                      NEED HORIZON REFERRAL FOR HMO AND ACCESS
     PPO, EPO, VISTA &
                                                                                                                                                                                          THALLIUM              PRI # 8583(*NYNM) FOR PLAN ONLY ,OTHERWISE PT WILL BE RESPONSIBLE FOR
    VISTA + OF NY AND                                                                                                                                                                                 NEED TO
                          ELIGIILITY                                                YES ONLY     YES ONLY     YES ONLY                                                                         &                ADDRESS( P.O BOX 79, PAYMENT.                  AS OF 7/1/03 WE NEED AUTH
    NJ WITH ID W ITH &                                            DOCTOR              FOR          FOR          FOR                                                                                  CALL INS &
                           MUST BE                                                                                                                                                        CARDIOLYT                 NEWARK NJ ) IF     FOR PET ,MRI'S , MRA'S AND NUCLEAR CARDIOLOGY
     W/OUT PREFIXES                                              REFERRAL         YKA,YKB,YKC, YKA,YKB,YKC, YKA,YKB,YKC,      NO             NO             NO               NO      NO               VERIFY IF
                         VERIFIED BY                                              YKD,YKF,YKG, YKD,YKF,YKG, YKD,YKF,YKG,                                                                     E FOR               DIFFERENT BILL ADD     ONLY*** FOR AUTH FOR VISTA, HORIZON EPO/PPO
        //HORIZON                                                 NEEDED                                                                                                                               AUTH
                            PHONE                                                  YKE PREFIX   YKE PREFIX   YKE PREFIX                                                                   YKA,YKB,Y                   ON INS CARD     CALL 800-234-7982 FOR AUTH FOR HMO CALL 866- 326-
        NETWORK                                                                                                                                                                                       NEEDED
                                                                                                                                                                                          KC,YKD,YK                    SEC-# 3308      3389 * (FILING TIME FOR MEDICAL CLAIMS IS 90
     TERMINATED ON
                                                                                                                                                                                          F,YKG, YKE                                                          DAYS)
           2/28/07
                                                                                                                                                                                            PREFIX


     HORIZON HMO &
                                                                                                                                                                                                                    PRI # 08583(*NYNM)
       HEALTHY NY &                                                                                                                                                                                     NEED TO
                          ELIGIILITY                              HORIZON                                                                                                                                         FOR ADDRESS( P.O BOX
      DIRECT ACCESS                                                                                                                                                                                    CALL INS &
                           MUST BE                               INSURANCE                                                                                                                                          79, NEWARK NJ ) IF
      PLAN//HORIZON                                                                  YES          YES          YES           YES             YES            YES              YES    YES      YES        VERIFY IF                             CALL 800-234-7982 FOR AUTH, AUTH MAY VARY….
                         VERIFIED BY                              REFERRAL                                                                                                                                         DIFFERENT BILL ADD
        NETWORK                                                                                                                                                                                          AUTH
                            PHONE                                 NEEEDED                                                                                                                                               ON INS CARD
     TERMINATED ON                                                                                                                                                                                      NEEDED
                                                                                                                                                                                                                         SEC-#01869
          2/28/07

    HORIZON LOCAL 223
     TOY & NOVELTY                                                                                                                                                                                      NEED TO
                         ELIGIILITY
   WORKERS OF AMERICA                                            DOCTORS                                                                                                                               CALL INS & CLAIM CENTER # 08370
                          MUST BE
          *PREFIX                                                REFERRAL            YES          YES           NO            NO             NO             NO               NO      NO      NO         VERIFY IF   (*NYNM) HORIZON                              212-889-8180
      ZJA**/HORIZON
                        VERIFIED BY
                                                                  NEEDED                                                                                                                                 AUTH           NETWORK
        NETWOTK            PHONE
                                                                                                                                                                                                        NEEDED
  TERMINATED ON 2/28/07
6/30/2010                                                                                                                  PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                        NPI DOSHI # 1720031339//Page 14
                                                                                                                     Doshi Diagnostic Imaging Services of New York
                                                                         REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                             REF REQ                                                                           AUTHORIZATION REQUIRED

                         INSURANCE WEB                                                                                CT SCAN &                                                                             NUCLEAR
                          SITE PRINT OUT                                               PET SCAN &                         CT                                                                               MEDICINE &       BREAST
        INSURANCE CO.                                        REFERRAL REQUIRED                        MRA & MRI                        SONO          MAMMO          X-RAYS                                                                    CLAIM CENTER                            COMMENTS
                            ELIGIBILITY                                                  PETCT                       ANGIOGRAPH                                                                             NUCLEAR         BIOPSY
                               FORM                                                                                       Y                                                    VASCULAR                    CARDIOLOGY
                                           WEBSITE ADDRESS                                                                                                                     STUDIES        ECHO

        HORIZON
                                                                                        NEED TO                                                                                                                           NEED TO
  LOCAL 298 PREFIX** ELIGIILITY
                                                                  DOCTORS              CALL INS &                                                                                                                        CALL INS & CLAIM CENTER # 05694
    ZJY *** HORIZON   MUST BE
                                                                  REFERRAL              VERIFY IF         NO             NO             NO             NO             NO              NO         NO            NO         VERIFY IF  ( *NYNM) HORIZON
       NETWORK       VERIFIED BY
                                                                   NEEDED                AUTH                                                                                                                              AUTH          NETWORK
   TERMINATED ON       PHONE
                                                                                        NEEDED                                                                                                                            NEEDED
          2/28/07

  HORIZON -LOCAL 560
  TRUCKING EMPLOYEE                                                                     NEED TO                                                                                                                           NEED TO
                      ELIGIILITY
  OF NJ WELFARE FUND                                              DOCTORS              CALL INS &                                                                                                                        CALL INS &       CLAIM CENTER # 00426
                       MUST BE
       //HORIZON                                                  REFERRAL              VERIFY IF         NO             NO             NO             NO             NO              NO         NO            NO         VERIFY IF        (*NYNM) HORIZON
                     VERIFIED BY
       NETWORK                                                     NEEDED                AUTH                                                                                                                              AUTH                NETWORK
                        PHONE
    TERMINATED ON                                                                       NEEDED                                                                                                                            NEEDED
          2/28/07



  HORIZON NJCF NEW
   JERSEY CARPENTER                                                                     NEED TO                                                                                                                           NEED TO
                     ELIGIILITY
     HEALTH FUNDS                                                 DOCTORS              CALL INS &                                                                                                                        CALL INS &       CLAIM CENTER09812 (
                      MUST BE
     *PREFIX ZJC**                                                REFERRAL              VERIFY IF         NO             NO             NO             NO             NO              NO         NO            NO         VERIFY IF       WITHOUT (*NYNM)**
                    VERIFIED BY
  HORIZON NETWORK                                                  NEEDED                AUTH                                                                                                                              AUTH             WE BILL DIRECT
                       PHONE
    TERMINATED ON                                                                       NEEDED                                                                                                                            NEEDED
         2/28/07



                                                                                        NEED TO                                                                                                                           NEED TO
                          ELIGIILITY
                                                                  DOCTORS              CALL INS &                                                                                                                        CALL INS &         PRI & -SEC-BILL
   H.E.R.E.I.U WELFARE     MUST BE                                                                                                                                                                                                                                CALL FOR AUTHORIZATION 800-624-1294 OR PHONE #
                                                                  REFERRAL              VERIFY IF        YES            YES            YES             YES           YES              YES        YES           YES        VERIFY IF       ADRESS ON BACK OF
     FUND LOCAL 54       VERIFIED BY                                                                                                                                                                                                                                         ON THE INSURANCE CARD
                                                                   NEEDED                AUTH                                                                                                                              AUTH               THE CARD
                            PHONE
                                                                                        NEEDED                                                                                                                            NEEDED

                                                                                        NEED TO                                                                                                                           NEED TO
                          ELIGIILITY
                                                                                       CALL INS &   YES,                                                                                                                 CALL INS &
        INDEPENDENT        MUST BE                             INS REFERRAL                                                                                                                                                                                       CALL UTILIZATION DEPARTMENT FOR AUTH. 800 654
                                                                                        VERIFY IF ALL MRI's              NO             NO             NO             NO              NO         NO            NO         VERIFY IF             # 03839
           HEALTH        VERIFIED BY                           NEED A MUST                                                                                                                                                                                                            5494.
                                                                                         AUTH     & MRA's                                                                                                                  AUTH
                            PHONE
                                                                                        NEEDED                                                                                                                            NEEDED

                                                                                        NEED TO                     INTEGRA          INTEGRA INTEGRA INTEGRAT            NEED TO                                                                                      WE PARTICIPATE WITH INTEGRATED HEALTH
                     ELIGIILITY                                                                   INTEGRAT INTEGRAT         INTEGRAT
                                                                INTEGRATED             CALL INS &                      TED              TED     TED     ED    INTEGRATE CALL INS &                                                                                NETWORK. THEY WILL SCHEDULE ALL APPOITMENTS.
  INTEGRATED HEALTH   MUST BE                                                                        ED       ED               ED                                                                                                          WC # 08498 PRIV#
                                                                HEALTH NET              VERIFY IF                    HEALTH           HEALTH HEALTH HEALTH D HEALTH VERIFY IF                                                                                     ATTACH REF DR# 24874 AS SEC DR. IHN ADDRESS IS
       NETWORK      VERIFIED BY                                                                    HEALTH   HEALTH           HEALTH                                                                                                              08687
                                                                   FORM                  AUTH                          NET              NET     NET     NET    NET FORM   AUTH                                                                                   125 STATE ST, STE 100 ,HACKENSACK, NJ 07601 800 672-
                       PHONE                                                                      NET FORM NET FORM         NET FORM
                                                                                        NEEDED                        FORM             FORM    FORM    FORM              NEEDED                                                                                                           3638.


     JEFFERSON PILOT
                                                                                        NEED TO                                                                                                                           NEED TO
    FINANCIAL FOR PPO     ELIGIILITY
                                                                   DOCTOR              CALL INS &                                                                                                                        CALL INS &                      PRI -
    AND TRADITIONAL        MUST BE
                                                                  REFERRAL              VERIFY IF         NO             NO             NO             NO             NO              NO         NO            NO         VERIFY IF       SEC-BILL ADRESS ON
     PLAN (FORMERLY      VERIFIED BY
                                                                   NEEDED                AUTH                                                                                                                              AUTH            BACK OF THE CARD
        CHUBB LIFE          PHONE
                                                                                        NEEDED                                                                                                                            NEEDED
         AMERICA)




                                                                                                                                                                                                                                                                   HERITAGE PROCESS CLAIMS FOR LIBERTY HEALTH
                                                                                                                                                                                                                                                                 ADVANTAGE MEMBER FIRST , CHECK PCP'S NAME ON
                                                                                                                                                                                                                                                             HERITAGE CAPITATED LIST, IF THE PCP IS CAP(X), CHECK THE
                                                                                                                                     NO, IF PCP                  YES, IF PCP   YES, IF PCP YES, IF PCP                                HCP CAP# 30061 (70000       HERITAGE CAP REPORT TO SEE IF THE PAT IS LISTED
                                                                 IF PCP IS PART OF  YES, IF PCP YES, IF PCP  YES, IF PCP            BELONGS TO      YES, IF PCP BELONGS TO     BELONGS TO BELONGS TO      YES, IF PCP  YES, IF PCP                             UNDERNEATH THE DOCTOR NAME. IF THE PATIENT IS NOT
                                                                   HEALTHCARE       BELONGS TO  BELONGS TO BELONGS TO               HCP/ AUTH IS    BELONGS TO HCP/ AUTH       HCP/ AUTH IS HCP/ AUTH IS  BELONGS TO   BELONGS TO     CPTS-NEED TO CHECK
                                                                                                                                                                                                                                                              LISTED CALL HERITAGE TO FIND OUT IF THE PAT IS PART OF
                                                              PARTNERS/ HERITAGE * HCP/ AUTH IS HCP/ AUTH IS HCP/ AUTH IS               NOT         HCP/ AUTH IS IS NEEDED       NEEDED       NEEDED      HCP/ AUTH IS HCP/ AUTH IS         PCP ON THE
                                           WWW.HCPIPA.COM    INSURANCE REFFERAL IS NEEDED FROM NEEDED FROM NEEDED FROM              NEEDED/NEE     NEEDED FROM      FROM          FROM         FROM      NEEDED FROM NEEDED FROM
                                                                                                                                                                                                                                                               HERITAGE /IF THEY TELL YOU THAT THE PAT BELONGS TO
                                                                                                                                                                                                                                       CAPITATED REPORT)
     LIBERTY HEALTH                                             NEEDED FROM PCP    HEALTH CARE HEALTH CARE HEALTH CARE              D ONLY HCP     HEALTH CARE    HEALTH         HEALTH       HEALTH     HEALTH CARE HEALTH CARE                               HERITAGE BILL NON-CAP # 30062 (PROCEDURES 70000 TO
                          ELIGIILITY                                                                                                                                                                                                ///// HCP NON CAP# 30062 79999 ARE CAPITATED). (PROCEDURES 90000 TO 99999 ARE NON
      ADVANTAGE /                                                    FROM HCP        PARTNERS    PARTNERS     PARTNERS                   INS         PARTNERS       CARE          CARE         CARE        PARTNERS     PARTNERS
                           MUST BE                                                                                                   REFERRAL                    PARTNERS       PARTNERS     PARTNERS                                     (ALL 90000 CPTS )   CAP,REGARDLESS OF WHETHER PRIMARY DR IS CAP. . NEED
    MEDICARE PLAN &
                         VERIFIED BY                                                                                                                                                                                                                             AUTH FOR ALL PROCEDURES . IF PCP IS NOT PART OF
      DUAL MCR/MCD
                         PHONE 1-866-                                                                                                                                                                                                                         HERITAGE BILL (LIBERTY HEALTH ADVANTAGE -SEE BELOW
     COVERAGE * SEE                                                                                                                                                                                                                                               GUIDELINES)       HERITAGE PHONE # (516) 746-2200
                           542-4269
       COMMENTS



                                                               IF PCP IS NOT PART OF
                                                                    HEALTHCARE
                                                                                         YES, GET       YES, GET       YES, GET       YES, GET       YES, GET       YES, GET    YES, GET        YES, GET
                                                                                                                                                                                                           YES, GET AUTH YES, GET AUTH                              FOR AUTHORIZATION CALL LIBERTY HEALTH
                                                                                         AUTH BY        AUTH BY        AUTH BY        AUTH BY        AUTH BY        AUTH BY     AUTH BY         AUTH BY
                                                              PARTNERS/ HERITAGE *                                                                                                                           BY CALLING    BY CALLING                             ADVANTAGE AT 212-642-3443 WHEN THE PCP IS NOT
                                                             INSURANCE REFFERAL IS
                                                                                         CALLING        CALLING        CALLING        CALLING        CALLING        CALLING     CALLING         CALLING
                                                                                                                                                                                                           LIBERTY AT 212- LIBERTY AT            #03341
                                                                                       LIBERTY AT     LIBERTY AT     LIBERTY AT     LIBERTY AT     LIBERTY AT     LIBERTY AT LIBERTY AT       LIBERTY AT                                                          PART OF HCP/HERITAGE .. AUTH IS REQUIRED FOR
                                                              NEEDED FROM LIBERTY                                                                                                                              642-3443    212-642-3443
                                                               MUTUAL INSURANCE*
                                                                                       212-642-3443   212-642-3443   212-642-3443   212-642-3443   212-642-3443   212-642-3443 212-642-3443   212-642-3443                                                                       ALL STUDIES …



         LIEN CASES
                                                                  DOCTORS                                                                                                                                                                                        CENTER MANAGERS SHOULD APPROVE LIEN CASES BY
      (ATTORNEY) see
                                                                  REFERRAL                 NO             NO             NO             NO             NO             NO              NO         NO            NO             NO                 #03384          SIGNING ON THE PATIENTS PAPERWORK. WE NEED THE
    COMMENTS FOR INF
                                                                   NEEDED                                                                                                                                                                                               ATTORNEY NAME, ADDRES & PHONE #.
          NEEDED
6/30/2010                                                                                                                           PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                                  NPI DOSHI # 1720031339//Page 15
                                                                                                          Doshi Diagnostic Imaging Services of New York
                                                                       REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                             REF REQ                                                             AUTHORIZATION REQUIRED

                         INSURANCE WEB                                                                     CT SCAN &                                                                  NUCLEAR
                          SITE PRINT OUT                                         PET SCAN &                    CT                                                                    MEDICINE &     BREAST
        INSURANCE CO.                                        REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                        CLAIM CENTER                         COMMENTS
                            ELIGIBILITY                                            PETCT                  ANGIOGRAPH                                                                  NUCLEAR       BIOPSY
                               FORM                                                                            Y                                                  VASCULAR           CARDIOLOGY
                                           WEBSITE ADDRESS                                                                                                        STUDIES     ECHO

                                                                                   CALL
                                                                                  UNION
                          ELIGIILITY
                                                                                   AND
             LOCAL         MUST BE                              DOCTORS
                                                                                  VERIFY         NO          NO           NO             NO             NO               NO     NO      NO           NO               # 00499
        15,15A,15C,15D   VERIFIED BY                         REFERAL NEEDED
                                                                                 WHETHER
                            PHONE
                                                                                  AUTH IS
                                                                                 NEEDED


                                                                              CALL
                                                                             UNION
                          ELIGIILITY
                                                                              AND
    LOCAL 210/ STRING      MUST BE                              DOCTORS
                                                 N/A                         VERIFY              NO          NO           NO             NO             NO               NO     NO      NO           NO          CLAIM CTR# 04767
        NETWORK          VERIFIED BY                         REFERAL NEEDED
                                                                            WHETHER
                            PHONE
                                                                             AUTH IS
                                                                            NEEDED




                                                                            YES FROM YES FROM YES FROM                                                                                                         FOR MRI,MRS, CT,PET
                                                                            MEDLINK, MEDLINK, MEDLINK,                                                                                                          BILL TO MEDLINK # BILL MEDLINK FOR MRI'S,MRAS, CT'S & PET
                          ELIGIILITY                                            BY       BY       BY                                                                                                              09110 // ALL OTHER
                                                                                                                                                                                                                                      SCANS .. BILL LOCAL 282 DIRECT FOR ANY
       LOCAL 282 -         MUST BE                              DOCTORS      CALLING  CALLING  CALLING                                                                                                            PROCEDURES BILL
                         VERIFIED BY
                                                 N/A
                                                             REFERAL NEEDED 888-558-  888-558- 888-558-
                                                                                                                          NO             NO             NO               NO     NO      NO           NO                               OTHER PROCEDURES///        FOR ELIG CALL
       MULTIPLAN                                                                                                                                                                                                      LOCAL 282
                            PHONE                                            0680 SEE 0680 SEE 0680 SEE                                                                                                         PRI - # 9409 (*NYNM)/ LOCAL 282 AT: 1-888-558-0680 // FOR AUTH
                                                                            COMMENT COMMENT COMMENT                                                                                                              SEC - # 5937 (W.OUT         CALL MEDLINK 888-558-0680
                                                                                 S        S        S                                                                                                                    *nynm )




                                                                              CALL
                          ELIGIILITY                                         UNION
    LOCAL 3- UNITED        MUST BE
                                                                DOCTORS
                                                                              AND
      STOREWORKERS       VERIFIED BY             N/A                         VERIFY              NO          NO           NO             NO             NO               NO     NO      NO           NO        CLAIM CENTER# 02830                CALL UNION 212-371-6230
                                                             REFERAL NEEDED
          UNION          PHONE 212-                                         WHETHER
                           371-6230                                          AUTH IS
                                                                            NEEDED




                                                                                  NEED TO                                                                                                          NEED TO
                          ELIGIILITY
                                                                DOCTORS          CALL INS &                                                                                                       CALL INS &                           GHI IS FOR HOSPITAL COVERAGE ONLY. THEREFORE
                           MUST BE                                                                                                                                                                              ALL OFFICES CLAIM
            LOCAL 377                                           REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO      NO         VERIFY IF                            GHI IS NOT PRIM OR SEC FOR US.PLEASE USE THE
                         VERIFIED BY                                                                                                                                                                              CENTER # 05415
                                                                 NEEDED            AUTH                                                                                                             AUTH                                         CLAIM CENTERS GIVEN TO BILL.
                            PHONE
                                                                                  NEEDED                                                                                                           NEEDED




                                                                                                                                                                                                   NEED TO
       LOCAL 580          ELIGIILITY
                                                                DOCTORS                                                                                                                           CALL INS &
   EDUCATIONAL FUND        MUST BE
                                                                REFERRAL                                          CONTRACTED TO DO CHEST X-RAY ONLY                                                VERIFY IF     CLAIM CTR 03832
     501-507 W. 42ND     VERIFIED BY
                                                                 NEEDED                                                                                                                             AUTH
     ST,NY,NY 10036         PHONE
                                                                                                                                                                                                   NEEDED




                                                                                  NEED TO                        LOCAL            LOCAL                             LOCAL
                          ELIGIILITY                                                        LOCAL 670 LOCAL 670        LOCAL 670                                            LOCAL   LOCAL 670     LOCAL 670
                                                                 DOCTOR          CALL INS &                       670              670                               670                                        CLAIM# 03804 (DON'T
                           MUST BE                                                            CLAIM     CLAIM            CLAIM                                            670 CLAIM   CLAIM         CLAIM
            LOCAL 670                                           REFERRAL          VERIFY IF                      CLAIM            CLAIM                             CLAIM                                        SEND CLAIMS TO          LOCAL 670 REQUIRES THE UNION CLAIM FORM.
                         VERIFIED BY                                                          FORM      FORM             FORM                                               FORM      FORM          FORM
                                                                 NEEDED            AUTH                          FORM             FORM                              FORM                                             (NYNM)
                            PHONE                                                            NEEDED    NEEDED           NEEDED                                             NEEDED    NEEDED        NEEDED
                                                                                  NEEDED                        NEEDED           NEEDED                            NEEDED




                                                                                  NEED TO                                                                                                          NEED TO
                     ELIGIILITY
                                                                 DOCTOR          CALL INS &                                                                                                       CALL INS &
      LOCAL 731       MUST BE                                                               AS OF 5/1/2006 EMPIRE HEALTH CHOICE IS PROCESSING THE MEDICAL CLAIMS FOR LOCAL                                       PLAN # 03407 (USE
                                                                REFERRAL          VERIFY IF                                                                                                        VERIFY IF
  (EXCAVATOR UNION) VERIFIED BY                                                                              731 // SEE GUIDELINE UNDER EMPIRE HEALTH CHOICE)                                                   PRIOR TO 5/1/06 DOS)
                                                                 NEEDED            AUTH                                                                                                             AUTH
                       PHONE
                                                                                  NEEDED                                                                                                           NEEDED


6/30/2010                                                                                                              PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                   NPI DOSHI # 1720031339//Page 16
                                                                                                                     Doshi Diagnostic Imaging Services of New York
                                                                                  REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                        REF REQ                                                             AUTHORIZATION REQUIRED

                              INSURANCE WEB                                                                           CT SCAN &                                                                        NUCLEAR
                               SITE PRINT OUT                                               PET SCAN &                    CT                                                                          MEDICINE &      BREAST
        INSURANCE CO.                                                   REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                                CLAIM CENTER                                 COMMENTS
                                 ELIGIBILITY                                                  PETCT                  ANGIOGRAPH                                                                        NUCLEAR        BIOPSY
                                    FORM                                                                                  Y                                                  VASCULAR                 CARDIOLOGY
                                                  WEBSITE ADDRESS                                                                                                            STUDIES      ECHO




                                                                                             NEED TO                        LOCAL            LOCAL                             LOCAL                                 NEED TO
                               ELIGIILITY                                                              LOCAL 734 LOCAL 734        LOCAL 734                                            LOCAL   LOCAL 734
                                                                                            CALL INS &                       734              734                               734                                 CALL INS &
                                MUST BE                                 LOCAL 734 CLAIM                  CLAIM     CLAIM            CLAIM                                            734 CLAIM   CLAIM                              ALL OFFICES BILL
            LOCAL 734                                                                        VERIFY IF                      CLAIM            CLAIM                             CLAIM                                 VERIFY IF
                              VERIFIED BY                                FORM NEEDED                     FORM      FORM             FORM                                               FORM      FORM                             CLAIM CENTER #02524
                                                                                              AUTH                          FORM             FORM                              FORM                                   AUTH
                                 PHONE                                                                  NEEDED    NEEDED           NEEDED                                             NEEDED    NEEDED
                                                                                             NEEDED                        NEEDED           NEEDED                            NEEDED                                 NEEDED




                                                                                                                                                                                                                                                         WHEN PATIENTS ARE CALLING TO MAKE
                                                                                                                                                                                                                                                   APPOITMENTS, LET THE THEM KNOW THAT WE NEED
                                                                                                                                                                                                                     NEED TO                       THE LOCAL CLAIM FORM TO BILL THE INSURANCE CO.
                               ELIGIILITY
                                                                                              CALL         PLEASE CALL LOCAL OR UNION TO FIND OUT IF THE MEMBER IS RESPONSIBLE FOR ANY                              CALL INS & CHECK BACK OR FRONT PLEASE TRY TO GET ORIGINAL LOCAL CLAIM FORM
    LOCALS & UNIONS,            MUST BE                                  LOCAL CLAIM
                                                                                            HICKSVILL      CO-PAY, CO-INSURANCE OR DEDUCTIBLE. IF THE MEMBER IS RESPONSABLE, PLEASE                                  VERIFY IF   OF THE CARD, FOR   FROM PATIENT. IF THEY DON’T HAVE IT GIVE THEM
         MISC.                VERIFIED BY                                FORM NEEDED
                                                                                                E                            COLLECT THE MONEY AT THE FRONT DESK.                                                     AUTH        MAILING ADDR       HCFA 1500 FORM TO SIGN AS WE CAN USE THAT AS
                                 PHONE
                                                                                                                                                                                                                     NEEDED                          CLAIM FORM. THIS IS A MUST.MAKE SURE PERSON
                                                                                                                                                                                                                                                     SIGNING THE FORM IS THE MEMBER OF THE UNION
                                                                                                                                                                                                                                                                   NOT DEPENDENT.




                                                                                                                                                                                                                                                              REMEMBER THIS IS A DISCOUNT INSURANCE CO .
      MC2 INSURANCE                                                                                         MC2 DISCOUNT PLAN . MUST COLLECT 75% FROM OUR STANDARD FROM PATIENT                                                      SELF PAY #00731
                                                                                                                                                                                                                                                                       PATIENTS ARE SELF -PAY




                                                                                                                                                                                                                                 00295 ( FOR 825 EAST GATE
                                                                                        YES/ MUST YES/ MUST YES/ MUST
                                                                                                                                                                                                                                   BLVD, GARDEN CITY, NY
                                                                                         CONFIRM   CONFIRM   CONFIRM                                                                                                 NEED TO                                FOR AUTHORIZATION CALL 1-516-222-6900. MAGNACARE HAS
                                ELIGIILITY                                                                                                                                                            YES, STRESS                 11530) IF DIFFERENT ADDR
   MAGNACARE *LOGO                                                                       FOR EACH  FOR EACH  FOR EACH                                                                                               CALL INS &                              MANY CLIENT-CONTRACTS, SO CONFIRM THE NECESSITY OF
                                 MUST BE                               DOCTORS REFERRAL                                                                                                               THALLIUM &                  OR SEC BILL ADDRESS ON
   ( PCMS) INSURANCE                            WWW.PCMS-MAGNACARE.COM                     PLAN      PLAN      PLAN                  NO              NO             NO              NO      NO                       VERIFY IF                             AUTHORIZATION FOR ANY MRI OR CAT SCAN. IF THE INS. REP
                               VERIFIED BY                                 NEEDED                                                                                                                     CARDIOLYTE                   INS CARD. / MUST ENTER
          CARD                                                                           WHETHER   WHETHER   WHETHER                                                                                                  AUTH                                 SAYS THAT AUTHORIZATION IS NOT NEEDED, GET THE FIRST &
                                 PHONE                                                                                                                                                                   ONLY                        GROUP NAME AND #
                                                                                          AUTH IS   AUTH IS   AUTH IS                                                                                                NEEDED                                LAST NAME OF THE REP AND PUT THIS INFO IN "NOTES " FIELD.
                                                                                                                                                                                                                                    NEEDED IN THE GROUP
                                                                                        NECESSARY NECESSARY NECESSARY
                                                                                                                                                                                                                                             FIELD




        MAGNACARE
        HMO PLANS
      MAGNAHEALTH
      Individual POS (eff
   4/1/96) Individual HMO                                                                                                                                                                                                        08364 ( MAGNACARE ,ATT:
                                                                                        YES/ MUST                                                                                                                                                          Magnahealth, 825 East Gate Blvd., 3rd Floor, Garden City, NY
   (eff 4/1/96) Met Council                                                                                                                                                                                                       P.O BOX DP100 825 EAST
                                                                                         CONFIRM                                                                                                                     NEED TO                                                          11530
          (eff 1/1/99)          ELIGIILITY                                                                                                                                                                                       GATE BLVD, GARDEN CITY,
                                                                                         FOR EACH        YES, ALL                                                                                                   CALL INS &
                                 MUST BE                               DOCTORS REFERRAL                               YES, ALL                                                                                                     NY 11530) IF DIFFERENT     (800) 235-7267 Ext. 593;     (516) 227-6900 Ext. 593
    GNY Auto (eff 1/1/97)                       WWW.PCMS-MAGNACARE.COM                     PLAN           MRI's &                    NO              NO             NO              NO    YES, NEED      YES         VERIFY IF
                               VERIFIED BY                                  NEEDED                                      CT's                                                                                                         ADDR OR SEC BILL     FOR PRE-CERTIFICATION / AUTHORIZATION CALL 1-888-
    Local 298 (eff 4/1/96)                                                               WHETHER          MRAs                                                                            TO CHECK                    AUTH
                                 PHONE                                                                                                                                                                                             ADDRESS ON INS CARD.     362 4624 /ALL MAGNACARE HMO PLANS NEED PRE-
      local 802 HMO(eff                                                                   AUTH IS                                                                                          FOR ALL                   NEEDED
                                                                                                                                                                                                                                 MUST ENTER GROUP NAME                         CERTIFICATION.
                                                                                        NECESSARY                                                                                          PLAN S(
            4/1/99)                                                                                                                                                                                                              AND # IN THE GROUP FIELD
    Local 868 (eff 8/1/96)                                                                                                                                                               FOR LOCAL
  Local 1199J (eff 10/1/96)                                                                                                                                                                91 NEED
                                                                                                                                                                                          PRE-CERT
  & LOCAL 88 WELFARE
                                                                                                                                                                                          FOR TEST
             FUND                                                                                                                                                                           OVER $
                                                                                                                                                                                            250.00)


                                                                                                                                                                                                                                                            CALL TELEPHONE ON THE I INSURANCE CARD TO FIND
                                                                                                                                                                                                                                                                  OUT IF THE MEMBER PLAN REQUIRES PRE-
                                                                                                                                                                                                                NEED TO
                               ELIGIILITY                                                                                                                                                                                                                        CERTIFICATION AND DEDUCTIBLE AND CO-
        MAGNACARE                                                           DOCTOR           YES,SEE YES,SEE YES,SEE                                                                                           CALL INS & HAVE DIFFERENTS P.O
                                MUST BE              WWW.PCMS-                                                                                                                                         YES,SEE                                              INSURANCE, AND COLLECT MONEY FROM PAT, MOST
       AMALGAMATED                                                         REFERRAL         COMMMEN COMMENT COMMENT                  NO             NO             NO               NO      NO                  VERIFY IF BOX#'S ,DEPENDING ON
                              VERIFIED BY          MAGNACARE.COM                                                                                                                                      COMMENTS                                               OF THE PLANS THAT THEY HAVE WILL NEEED AUTH
         /ALICARE                                                           NEEDED             TS       S       S                                                                                                AUTH      THE MEMBER'S PLAN
                                 PHONE                                                                                                                                                                                                                      FOR MR'IS, MRA'S & CTS. . IF NO CARD CALL (800) 332-
                                                                                                                                                                                                                NEEDED
                                                                                                                                                                                                                                                               5426 , SOME PLANS BELONG TO MULTIPLAN(SEE
                                                                                                                                                                                                                                                                        MULTIPLAN REQUIRETMENTS)


                                                                                              YES/
                                                                                              MUST
                                                                                                                                                                                                         YES,
                                                                                            CONFIRM                                                                                                              NEED TO
                               ELIGIILITY                                                                                                                                                               STRESS                                              CALL AND GET AUTHORIZATION FOR ALL MRI'S, MRA'S,
                                                                            DOCTOR          FOR EACH     YES, ALL                                                                                               CALL INS &
      MAGNACARE                 MUST BE              WWW.PCMS-                                                       YES, ALL                                                                         THALLIUM                                               CT'S ,CARDIOLYTE AND STRESS THALLIUM. 800-220-
                                                                           REFERRAL           PLAN       MRI'S &                     NO             NO             NO               NO      NO                   VERIFY IF            CLAIM # 02974
   BENEFITS CONCEPTS          VERIFIED BY          MAGNACARE.COM                                                       CT's                                                                                &                                                 2600.    PRE-CERTIFICATIONS MAY VARY BY PLAN
                                                                            NEEDED          WHETHER       MRAS                                                                                                    AUTH
                                 PHONE                                                                                                                                                                CARDIOLYT                                                           SPONSOR(CONTRACTS)
                                                                                             AUTH IS                                                                                                             NEEDED
                                                                                                                                                                                                        E ONLY
                                                                                            NECESSAR
                                                                                                Y




6/30/2010                                                                                                                         PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                                   NPI DOSHI # 1720031339//Page 17
                                                                                                              Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                                    AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                          CT SCAN &                                                                           NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                         CT                                                                             MEDICINE &         BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                  MRA & MRI                       SONO          MAMMO          X-RAYS                                                                       CLAIM CENTER                               COMMENTS
                           ELIGIBILITY                                            PETCT                       ANGIOGRAPH                                                                           NUCLEAR           BIOPSY
                              FORM                                                                                 Y                                                    VASCULAR                  CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                               STUDIES      ECHO


                                                                                                                                                                                                                   NEED TO
                         ELIGIILITY
                                                                DOCTOR                          YES, ALL                                                                                                          CALL INS &
        MAGNACARE         MUST BE            WWW.PCMS-                                                        YES, ALL                                                                                                                                                 CALL MET COUNCIL UNION TO GET PRE-
                                                               REFERRAL            YES          MRI'S &                         NO             NO             NO               NO       NO             NO          VERIFY IF        CLAIM CENTER # 08364
        MET COUNCIL     VERIFIED BY        MAGNACARE.COM                                                        CT's                                                                                                                                                  CERTIFICATION FOR PET,MRIS,MRAS, & CT
                                                                NEEDED                           MRAS                                                                                                               AUTH
                           PHONE
                                                                                                                                                                                                                   NEEDED



                                                                                CALL 800- CALL 800- CALL 800-                                                                                      CALL 800- CALL 800-
                      ELIGIILITY                                                 937-6542  937-6542  937-6542                                                                                     937-6542 TO 937-6542 TO  PLAN CODE# 00295
   MAGNACARE NIPPON                                             DOCTOR
                       MUST BE               WWW.PCMS-                          TO VERIFY TO VERIFY TO VERIFY                                                                                       VERIFY      VERIFY (MAGNACARE) 825 EAST                       ENTER EMPLOYER AND GROUP # OR NAME IN THE
   LIFE INSURANCE OF                                           REFERRAL                                                         NO             NO             NO               NO       NO
                     VERIFIED BY           MAGNACARE.COM                        WHETHER WHETHER WHETHER                                                                                            WHETHER WHETHER        GATE BLVD GARDEN                                      GROUP FIELD
         AMERICA                                                NEEDED
                        PHONE                                                    AUTH IS   AUTH IS   AUTH IS                                                                                        AUTH IS     AUTH IS      CITY NY 11530
                                                                                 NEEDED    NEEDED    NEEDED                                                                                         NEEDED     NEEDED




                         ELIGIILITY
                                                               DOCTORS
   MAGNACARE LOCAL        MUST BE            WWW.PCMS-
                                                               REFERRAL             NO             NO             NO            NO             NO             NO               NO       NO             NO              NO               CLAIM # 00006
       1181 DIV.        VERIFIED BY        MAGNACARE.COM
                                                                NEEDED
                           PHONE



                         ELIGIILITY
   MAGNACARE LOCAL                                                                                                                                                                                                                  PLAN # 03630 (INDECS)
                          MUST BE                              DOCTORS
    148 9PRODUCTION                          WWW.PCMS-                                                                                                                                                                                   P.O BOX 435
                        VERIFIED BY                            REFERRAL             NO             NO             NO            NO             NO             NO               NO       NO             NO              NO                                                          888-225-0324
    WORKERS UNION                          MAGNACARE.COM                                                                                                                                                                             ,E.RUTHERFORD,NJ
                        PHONE 888-                              NEEDED
     WELFARE FUND                                                                                                                                                                                                                           07073
                          225-0324


                                                                                  YES/
                                                                                  MUST
      MAGNACARE
                                                                                CONFIRM
        LOCAL 174        ELIGIILITY
                                                               DOCTORS            WITH
    AFFILIATED TRUST      MUST BE            WWW.PCMS-
                                                               REFERRAL         LOCAL 174          NO             NO            NO             NO             NO               NO       NO             NO              NO               CLAIM # 01738                              212-307-7007
    FUND *COLLECT $     VERIFIED BY        MAGNACARE.COM
                                                                NEEDED           UNION ,
    25.00 /COPAY FOR       PHONE
                                                                                WHETHER
          XRAYS
                                                                                 AUTH IS
                                                                                 NEEDED


                                                                                                                                                             YES,
                                                                                                                                YES,                       AUTH IS         YES,         YES,
                                                                                                              YES, AUTH       AUTH IS     YES, AUTH       NEEDED /       AUTH IS      AUTH IS      YES, AUTH      YES, AUTH
                    ELIGIILITY                                                  YES, AUTH      YES, AUTH      IS NEEDED      NEEDED /     IS NEEDED          CALL       NEEDED /     NEEDED /     IS NEEDED /     IS NEEDED
                     MUST BE                                                    IS NEEDED      IS NEEDED      / CALL THE     CALL THE     / CALL THE         THE        CALL THE     CALL THE      CALL THE       / CALL THE PLAN CODE # 00295 (AS AS OF 1/1/07 ALL CLAIMS FOR DC1707/389 ARE BEING
                                                               DOCTORS
   MAGNACARE LOCAL VERIFIED BY               WWW.PCMS-                          / CALL THE     / CALL THE      LOCAL AT      LOCAL AT      LOCAL AT         LOCAL       LOCAL AT     LOCAL AT     LOCAL AT 1-     LOCAL AT 1- OF 12/1/06 bill Magnacare )   PROCESS BY MAGANCARE.. FOR AUTH CALL THE
                                                               REFERRAL
      DC 1707/389   PHONE BY               MAGNACARE.COM                         LOCAL AT       LOCAL AT       1-866-624-    1-866-624-    1-866-624-     AT 1-866-     1-866-624-   1-866-624-   866-624-6258      866-624-   prior to 12/1/06 bill 01042 UNION AT 866-624-6258 .. FOR ELIG CALL 1-866-624-
                                                                NEEDED
                   CALLING 866-                                                  1-866-624-     1-866-624-     6258 FOR      6258 FOR      6258 FOR        624-6258     6258 FOR     6258 FOR         FOR          6258 FOR    (*nynm) Horizon Network                            6258
                     624-6258                                                       6258           6258        CHARGES       CHARGES       CHARGES           FOR        CHARGES      CHARGES       CHARGES         CHARGES
                                                                                                              OVER $500        OVER       OVER $500       CHARGES         OVER         OVER        OVER $500      OVER $500
                                                                                                                                $500                        OVER           $500         $500
                                                                                                                                                             $500



                                                                                YES, NEED TO   YES, NEED TO   YES, NEED TO
                     ELIGIILITY                                                     CALL           CALL           CALL
                                                                                                                                                                                                   YES, NEED TO    YES, NEED TO       BILL MAGNACARE
                      MUST BE                                  DOCTORS                                                                                                                                 CALL            CALL         NETWORK AS OF 1/1/07          AS OF 1/1/07 DC 1707 HAS MAGNACARE NETWORK//
                                                                                MAGNACARE      MAGNACARE      MAGNACARE
                                             WWW.PCMS-                                                                                                                                             MAGNACARE       MAGNACARE
  MAGNACARE DC 1707 VERIFIED BY                                REFERRAL          AT 800-235-    AT 800-235-    AT 800-235-      NO             NO             NO               NO       NO        AT 800-235-7267 AT 800-235-7267    (address on the ins card)   FOLLOW INS CARD FOR AUTH REQUIREMENTS DC1707
                                           MAGNACARE.COM                          7267 TO        7267 TO        7267 TO
                     PHONE BY                                   NEEDED                                                                                                                             TO VERIFY IF    TO VERIFY IF      prior to 1/1/07 bill plan              DIRECT LOCAL # IS 212-334-0096
                                                                                 VERIFY IF      VERIFY IF      VERIFY IF
                    CALLING 212                                                                                                                                                                    AUTH IS REQ     AUTH IS REQ         code 08846 (*nynm)
                                                                                AUTH IS REQ    AUTH IS REQ    AUTH IS REQ




                                                                                               YES, MRA'S                                                                                          YES, ONLY                        AS OF 1/1/07 LOCAL 272
                                                                                                          YES, ALL
                      ELIGIILITY                                                YES, THRU       & MRA'S                                                                                            NUCLEAR                                IS PART OF
    MAGNACARE LOCAL                                            DOCTORS                                    CTS THRU
                       MUST BE               WWW.PCMS-                           ALICARE         THRU                                                                                             CARDIOLOG                         MAGNACARE NETWORK FOR ELIGIBILITY VERIFICATION CALL LOCAL 212-726-
    272 WELFARE FUND                                           REFERRAL                                    ALICARE              NO             NO             NO               NO       NO                             YES
                     VERIFIED BY           MAGNACARE.COM                         800-332-       ALICARE                                                                                             Y THRU                           BILL # 00295 PRIOR #  9730 ///// FOR AUTHO CALL ALICARE AT 800*332-5423
      *PREFIX ZJD **                                            NEEDED                                     800-332-
                        PHONE                                                      5426         800-332-                                                                                            ALICARE                           02149 DDIS PLANC
                                                                                                             5426
                                                                                                  5426                                                                                            800-332-5426                               CODE


                                                                                  CALL
                                                                                 UNION
                         ELIGIILITY
                                                               DOCTORS            AND
   MAGNACARE LOCAL        MUST BE            WWW.PCMS-
                                                               REFERRAL          VERIFY            NO             NO            NO             NO             NO               NO       NO             NO              NO               CLAIM # 00598
     298 AFL-CIO        VERIFIED BY        MAGNACARE.COM
                                                                NEEDED          WHETHER
                           PHONE
                                                                                 AUTH IS
                                                                                NEEDED
6/30/2010                                                                                                                    PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                                        NPI DOSHI # 1720031339//Page 18
                                                                                                         Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                             AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                     CT SCAN &                                                                    NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                    CT                                                                      MEDICINE &   BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                       CLAIM CENTER                           COMMENTS
                           ELIGIBILITY                                            PETCT                  ANGIOGRAPH                                                                    NUCLEAR     BIOPSY
                              FORM                                                                            Y                                                  VASCULAR             CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                        STUDIES     ECHO




  MAGNACARE LOCAL 3
                                                                                                                                                                                                                                        COLLECT $25.00 COPAY FOR CTS, 'MRIS,NUCLEAR
      /PENSION &     ELIGIILITY
                                                               DOCTORS           NO. SEE NO. SEE NO. SEE NO. SEE NO. SEE NO. SEE NO. SEE NO. SEE           NO. SEE                                                                       STUDIES,SONOGRAMS, VASCULAR STUDIES,PET
   HOSPITALIZATION    MUST BE                WWW.PCMS-                                                                                            NO. SEE
                                                               REFERRAL         COMMENT COMMENT COMMENT COMMEN COMMENT COMMEN COMMEN COMMEN               COMMENT                                                CLAIM# 00295          SCAN,X-RAYS AND EKG …. FOR ALL OTHER STUDIES;
   AND BENEFIT PLAN VERIFIED BY            MAGNACARE.COM                                                                                         COMMENTS
                                                                NEEDED             S       S       S       TS      S       TS      TS      TS                S                                                                        NEED TO CALL THE UNION TO VERIFY COPAY AMOUNT
  OF THE ELECTRICAL    PHONE
                                                                                                                                                                                                                                               OR IF IT IS NEEDED ..718-591-1100
       INDUSTRY




                                                                                YES, NEED YES, NEED YES, NEED
                    ELIGIILITY
                                                               DOCTORS           TO CALL    TO CALL    TO CALL
   MAGNACARE LOCAL   MUST BE                 WWW.PCMS-                                                                                                                                                                                CALL UNION AT 1-914-478-5337 AND VERIFY WHETHER
                                                               REFERRAL         UNION AT UNION AT UNION AT               NO             NO             NO               NO     NO        NO         NO       CLAIM CENTER # 00295
      305 HEALTH   VERIFIED BY             MAGNACARE.COM                                                                                                                                                                               AUTH IS NEEDED FOR PET,MRI, MRA,CT,CT STUDIES
                                                                NEEDED          1-914-478- 1-914-478- 1-914-478-
                      PHONE
                                                                                   5337       5337       5337



                         ELIGIILITY                              DOCTORS           YES, NEED YES, NEED
                          MUST BE                               REFERRAL            TO CALL   TO CALL
   MAGNACARE LOCAL                                                                                                                                                                                                                      AS OF 8/1/05 MAGNACARE PROCESS ALL MEDICAL
                        VERIFIED BY          WWW.PCMS-      NEEDED & $20.00 UNION AT UNION AT
     338 HEALTH &                                                                                           NO           NO             NO             NO               NO     NO        NO         NO       CLAIM CENTER # 00295        CLAIMS FOR LOCAL 338 // PRIOR TO 8/1/05 WAS
                        PHONE 718-         MAGNACARE.COM        copay for all       718-997-  718-997-
    WELFARE FUND                                                                                                                                                                                                                                     MULTIPLAN NETWORK
                         997-7400 ext                        Diagnostic services    7400 EXT  7400 EXT
                             776                            (one co-pay per visit)     776       776


                     ELIGIILITY
                                                                                                                                                                                                                # 01738 (MALONEY
                      MUST BE                                  DOCTORS
   MAGNACARE LOCAL                           WWW.PCMS-                                                                                                                                                           ASSOCIATES-211
                    VERIFIED BY                                REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO        NO         NO                                             MALONEY-516-887-2255
   342 WELFARE FUND                        MAGNACARE.COM                                                                                                                                                           BROADWAY
                    PHONE 516-                                  NEEDED
                                                                                                                                                                                                              ,LYNBROOK NY 11563
                      887-2255


                         ELIGIBILITY
                          MUST BE                              DOCTORS
   MAGNACARE LOCAL                           WWW.PCMS-
                         VERIFY BY                             REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO        NO         NO               30035                       CALL UNION AT 516-248-2396
         381                               MAGNACARE.COM
                        CALLING 516-                            NEEDED
                          248-2396


                         ELIGIILITY
                                                               DOCTORS
   MAGNACARE LOCAL        MUST BE            WWW.PCMS-
                                                               REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO        NO         NO              #00295
   707 ROAD CARRIERS    VERIFIED BY        MAGNACARE.COM
                                                                NEEDED
                           PHONE


                         ELIGIILITY                                              NEED TO
                          MUST BE                              DOCTORS          CALL INS &                                                                                                                   # 02120 (LOCAL 806) 40
        MAGANACARE                           WWW.PCMS-
                        VERIFIED BY                            REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO        NO         NO       WEST 27TH STREET NY
         LOCAL 806                         MAGNACARE.COM
                        PHONE 212-                              NEEDED            AUTH                                                                                                                       NY 10001 212-447-0149
                          447-0149                                               NEEDED


                                                                                                                                                      NO,
                                                                                                                   NO, ONLY                                      NO, ONLY    NO, ONLY
                                                              FOR PATIENTS                                                                           ONLY
                                                                                 NO, ONLY     NO, ONLY    NO, ONLY UNITED           NO, ONLY                      UNITED      UNITED              NO, ONLY
                                                              REFERRED BY                                                                           UNITED                              NO, ONLY
                                                                                  UNITED       UNITED      UNITED    WIRE            UNITED                         WIRE        WIRE               UNITED
                                                              UNITED METAL                                                                            WIRE                               UNITED
                                                                                   WIRE         WIRE        WIRE   ,METAL -           WIRE                       ,METAL -    ,METAL -               WIRE
                                                              /LOCAL 810 -10                                                                       ,METAL -                               WIRE
                                                                                 ,METAL -     ,METAL -    ,METAL -  LOCAL           ,METAL -                       LOCAL       LOCAL              ,METAL -
                                                            EAST 15TH STREET                                                                         LOCAL                              ,METAL -             CLAIM CENTER #08183
                                                                                LOCAL 810    LOCAL 810   LOCAL 810    810          LOCAL 810                         810         810             LOCAL 810                                 NATIONAL HEALTH PLAN 212-279-3232 ///
                                                                NYNY 10003                                                                             810                             LOCAL 810                  LOCAL 810
                                                                                INSURANC     INSURANC    INSURANC INSURAN          INSURANC                      INSURAN     INSURAN             INSURANC
                                                            MEDICAL CENTER                                                                         INSURAN                            INSURANCE
                                                                                     E            E           E       CE                E                            CE          CE                   E
                                                                 DOCTORS                                                                               CE                              REFERRAL
                                                                                REFERRAL     REFERRAL    REFERRAL REFERRA          REFERRAL                      REFERRA     REFERRA             REFERRAL
                                                             LOCAL 810 REF IS                                                                      REFERRA                             IS NEEDED
                                                                                IS NEEDED    IS NEEDED   IS NEEDED   L IS          IS NEEDED                        L IS        L IS             IS NEEDED
                                                                 NEEDED                                                                               L IS
                                                                                                                   NEEDED                                         NEEDED      NEEDED
  MAGNACARE LOCAL    ELIGIILITY                                                                                                                     NEEDED
   810 UNITED WIRE    MUST BE
                                             WWW.PCMS-
  METAL AND MACHINE VERIFIED BY                                FOR PATIENTS
                                           MAGNACARE.COM
   HEALTH WELFARE   PHONE 212-                                 THAT ARE NOT
        FUND          691-4100                                 REFERRED BY
                                                            UNITED MEDICAL
                                                                               YES,BY    YES,BY    YES,BY
                                                                LOCAL 810
                                                                              CALLING   CALLING   CALLING
                                                            MEDICAL CENTER                                                                                                                                                        AS OF 1/1/07 ALL CLAIMS FOR UNITED WIRE METAL
                                                                              ALICARE   ALICARE   ALICARE
                                                                 DOCTORS                                                                                                                                     BILL MAGNACARE PLAN WELFARE FUND ARE BEING PROCESS BY MAGNACARE
                                                                              800-332-  800-332-  800-332-               NO             NO             NO               NO     NO        NO         NO
                                                                * NO REF IS                                                                                                                                       CODE #00295       .. FOR AUTH CALL ALICARE AT 800-332-5426 ..
                                                                             5426 PLUS 5426 PLUS 5426 PLUS
                                                                  NEEDED                                                                                                                                                                 NATIONAL HEALTH PLAN 212-279-3232
                                                                                $50.00    $50.00    $50.00
                                                              *MEMBER NEED
                                                                               COPAY     COPAY     COPAY
                                                            TO PAY $50 COPAY
                                                                 FOR PET
                                                             ,MRI,MRAS & CTS
                                                                  STUDIES

6/30/2010                                                                                                             PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                    NPI DOSHI # 1720031339//Page 19
                                                                                                                   Doshi Diagnostic Imaging Services of New York
                                                                                REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                      REF REQ                                                             AUTHORIZATION REQUIRED

                           INSURANCE WEB                                                                            CT SCAN &                                                                   NUCLEAR
                            SITE PRINT OUT                                                PET SCAN &                    CT                                                                     MEDICINE &   BREAST
        INSURANCE CO.                                                 REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                      CLAIM CENTER                                  COMMENTS
                              ELIGIBILITY                                                   PETCT                  ANGIOGRAPH                                                                   NUCLEAR     BIOPSY
                                 FORM                                                                                   Y                                                  VASCULAR            CARDIOLOGY
                                             WEBSITE ADDRESS                                                                                                               STUDIES     ECHO




                             ELIGIILITY
   MAGNACARE LOCAL            MUST BE          WWW.PCMS-              DOCTORS REFERRAL                                                                                                                                    PLAN # 03065            CALL LOCAL AT 516-833-9300 OR MAGNACARE 1800-235-7267 //
                                                                                             NO           NO          NO           NO              NO             NO              NO     NO       NO         NO
         854                VERIFIED BY      MAGNACARE.COM                 NEEDED                                                                                                                                     (DICKINSON GROUP)                AS OF 10/1/06 BILL UNDER MAGNACARE NETWORK
                              PHONE




                            ELIGIILITY
                                                                                                                                                                            ONLY IF ONLY IF
                             MUST BE
                                                                         DOCTORS                                                                                              THE      THE
   MAGNACARE LOCAL         VERIFIED BY          WWW.PCMS-                                                                                                                                                                                           FOR LOCAL 91 NEED PRE-CERTIFICATION FOR ANY
                                                                         REFERRAL           YES          YES          YES          NO             NO             NO        STUDY IS STUDY IS      YES        YES              #08364
    91 UNITED CRAFT        PHONE WITH         MAGNACARE.COM                                                                                                                                                                                                       TEST OVER $ 250.00
                                                                          NEEDED                                                                                             OVER     OVER
                            LOCAL 91
                                                                                                                                                                            $250.00  $250.00
                              UNION




                            ELIGIILITY
                             MUST BE
                           VERIFIED BY
                           PHONE WITH                                    DOCTORS
   MAGNACARE LOCAL                              WWW.PCMS-
                            LOCAL 918                                    REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO       NO         NO               #00295
    918 TEMASTERS                             MAGNACARE.COM
                           BY CALLING                                     NEEDED
                           718-842-1212
                            OR 718-258-
                               9180


                            ELIGIILITY
                                                                          DOCTOR
      MASHANTUCKET           MUST BE
                                                                         REFERRAL             AS OF 4/1/05 THIS INSURANCE IS PART OF HEALTH NET/CARE CORE*** SEE HEALTH NET GUIDELINES                                         03105
       PEQUOT INS          VERIFIED BY
                                                                          NEEDED
                              PHONE


    MEDICAL EXPRESS                                                                    NEED TO                                                                       NEED TO
                            ELIGIILITY                                                            MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL                                                                                 MEDICAL EXPRESS, INC. WILL AUTH. PATIENT TO COME
    HOUSE CALLS INC                                                                   CALL INS &                                                                    CALL INS &
                             MUST BE                                  MEDICAL EXPRESS             EXPRESS EXPRESS EXPRESS EXPRESS EXPRESS EXPRESS EXPRESS   EXPRESS                                                                                TO OUR CENTERS AND THEY WILL CALL AND MAKE
     613 EAST 49TH                                                                     VERIFY IF                                                                     VERIFY IF                                                # 00909
                           VERIFIED BY                                APPROVAL FORM              APPROVAL APPROVAL APPROVA APPROVAL APPROV APPROVA APPROVA APPROVAL                                                                                APPOINTMENT. PHONE # 888-840-5075 FAX#800-447-
   STREET HIALEAH FL                                                                    AUTH                                                                          AUTH
                              PHONE                                                                FORM     FORM    L FORM   FORM   AL FORM L FORM  L FORM   FORM                                                                                                        2123
          33013                                                                        NEEDED                                                                        NEEDED



                            ELIGIILITY
                                                                                           PATIENTS WILL HAVE MEDICAL SAVERS INSURANCE CARD AND DR'S REF OR SCRIPT. ONLY ACCEPT
     MEDICAL SAVERS          MUST BE                                     DOCTORS
                                                                                           CASH,CHECK OR CREDIT CARD. FOR FEE SCHEDULE GO TO /M13 OPTION #1 AND LOOK FOR MEDICAL                                         SELF PAY #00731
         GROUP             VERIFIED BY                                REFERAL NEEDED
                                                                                                                             SAVERS GROUP FEE.
                              PHONE



                                                                                                                                                                                                                                               CHECK TO SEE IF THE REF. DOCTOR BELONG TO
                MEDICAID                                                                                                                                                                                                                      LUTHERAN HOSPITAL FOR XRAYS AND FLUORO
                            NEED UT-
            **CHECK FOR                                                                                                                                                                                                 PRIMARY # 00564       (CHECK - LIST) WHEN DOING UT FOR MEDICAID
                             PRINT                                       DOCTORS
              MEDICAID                       https://www.emedny.org                          NO           NO          NO           NO             NO             NO               NO     NO       NO         NO        SEC # 01769 PET      PATIENTS MAKE SURE TO SELECT OPTION 1 /AUTH **
                            OUT/SEE                                   REFERAL NEEDED
            ELEGIBILITY*                                                                                                                                                                                             SCANS -PRI/SEC # 30028 CHECK THE UT SLIP FOR ANY INSURANCE COVERAGE
                           COMMENTS
             AND HMO'S                                                                                                                                                                                                                       CODE SHOWING AND REFER TO THE MEDICAID HMO
                                                                                                                                                                                                                                                         LIST FOR PAYER NAME**


                                                                                                                                                TECH
                                                                                                                                               MUST
                                                                                                                      (MCR
                                                                                                                                              INFORM                                                                   BILL CLAIM # 00001         MEDICARE IS NOW COVERING BONE DENSITY & DEXA
        MEDICARE                                                                                                    COVERS
                                                                                                                                               FRONT                                                                  FOR FL/JH/FH ////////          TEST ONCE EVERY TWO YEARS. NEED ABN FORM
      (ALWAYS CALL      ELIGIILITY                                                                                   76075-
                                                                                                                                              DESK IF                                                                 //BILL CLAIM # 05467        SIGNED BY PAT FOR ALL BROOKLYN ,TRIBECA AND WH
      MEDICARE FOR       MUST BE                                                                                     DEXA
                                                                                                                                             SCREENIN                                                                  FOR BH/MB/BR/WL/            OFFICES *** ROUTINE MAMMO CAN BE DONE ONCE A
   DEDUCTIBLE (AS OF VERIFIED BY                                         DOCTORS                                     ONCE                                                                         NO,
                                                                                                                                                G OR                                                                 ML/HW/BOND ST/ WN//          YEAR ONLY *** . FOR MAMMOGRAM SEE MEMO WHICH
      1/1/2006 DED IS    PHONE &                                         REFERRAL            NO           NO        EVERY          NO                            NO               NO     NO       SEE        NO
                                                                                                                                             DIAGNOST                                                                     PB //RC, FRD,STILL       EXPLAIN DIFFERENCE BETWEEN SCREENING MAMMO
   $131.00 ) & COLLECT FORM NEEDS                                         NEEDED                                      TWO                                                                      COMMENTS
                                                                                                                                                  IC                                                                     WELL, MIDW,UPW -              AND DIAGNOSTIC MAMMO AND ADD VIEWS.
      20% MEDICARE        TO BE                                                                                      YEARS
                                                                                                                                              MAMMO,                                                                    /////// //// BILL CLAIM     *CHIROPRACTOR CAN NOT REFER ANY MEDICARE
   APPROVED AMOUNT/ COMPLETED                                                                                          /SEE
                                                                                                                                              otherwise                                                                CENTER # 08351 FOR                   PATIENTS FOR ANY PROCEDURE.
  IF NO SEC INSURANCE                                                                                              COMMENT
                                                                                                                                                enter                                                                     TRI & WHTS & HM                  COLLECT 20%% IF NO SECONDARY
                                                                                                                         S
                                                                                                                                              screening
                                                                                                                                               mammo




6/30/2010                                                                                                                       PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                          NPI DOSHI # 1720031339//Page 20
                                                                                                             Doshi Diagnostic Imaging Services of New York
                                                                          REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                REF REQ                                                             AUTHORIZATION REQUIRED

                         INSURANCE WEB                                                                        CT SCAN &                                                                    NUCLEAR
                          SITE PRINT OUT                                            PET SCAN &                    CT                                                                      MEDICINE &     BREAST
        INSURANCE CO.                                           REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                         CLAIM CENTER                           COMMENTS
                            ELIGIBILITY                                               PETCT                  ANGIOGRAPH                                                                    NUCLEAR       BIOPSY
                               FORM                                                                               Y                                                  VASCULAR             CARDIOLOGY
                                           WEBSITE ADDRESS                                                                                                           STUDIES     ECHO
                                                                                                                (MCR                      TECH
                                                                                                              COVERS                     MUST
                                                                                                               76075-                   INFORM                                                                                             ROUTINE MAMMO CAN BE DONE ONCE A YEAR , AND
                          ELIGIILITY
                                                                                                               DEXA                      FRONT                                                                                             DEXA CAN BE DONE ONCE EVERY TWO YEARS. I**.
            MEDICARE       MUST BE                                 DOCTORS
                                                                                       NO           NO         ONCE          NO         DESK IF            NO               NO     NO        NO           NO              # 00091            FOR MAMMOGRAM SEE MEMO WHICH EXPLAIN
            RAILROAD     VERIFIED BY                            REFERAL NEEDED
                                                                                                              EVERY                    SCREE. OR                                                                                            DIFFERENCE BETWEEN SCREENING MAMMO AND
                            PHONE
                                                                                                                TWO                      DIAGN                                                                                               DIAGNOSTIC MAMMO, ALSO ADD VIEW MAMOS
                                                                                                               YEARS                    MAMMO,
                                                                                                                 /SEE                   otherwise
                                                                                                             COMMENT                       enter
                                                                                                                     NEED
                                                                                                                     AUTH
                                                                                                                   FOR 76645
                                                                                                                    BREAST                                                                                                                  REFERRING PHYSCIAN IS REQUIRED TO GET AUTH#'S
                                                                                                 YES,                                                                                      YES, ALL
                                                                                     YES, ALL             YES, ALL SONO ///                                                                                                                FROM CARECORE-MDNY. WE CAN VERRIFY AUTH ON
                     ELIGIILITY                                                                ALL MRI's                                                                                   NUCLEAR
   MDNY HEALTH CARE                                                 DOCTOR          PET SCANS            CT'S NEED FOR OB,                                                                                                                 CARECORE WEBSITE OR CALL 1--800-934-7153 AUTH IS
                      MUST BE                                                                  & MRA's                                                                                    MEDICINE
   HMO,POS,HEALTHY              WWW.CARECORENATIONAL.              REFERRAL           NEED                 AUTH#   TV SONO                  NO             NO               NO     NO                     NO         CLAIM CTR # 04888        VALID FOR 45 DAYS ONLY!! TO VERIFY MEMBER
                    VERIFIED BY                                                                 NEED                                                                                      TEST NEED
     NY,LIA PLANS                   COM FOR AUTH                    NEEDED          AUTH PER              PER CPT    NEED                                                                                                                   ELEGIBILITY/BENEFITS CALL 1-800-934-7153 OR 1-800-
                       PHONE                                                                  AUTH# PER                                                                                   AUTH# PER
                                                                                       CPT                 CODE      AUTH                                                                                                                     909-1970 PRESS PROMPT 1. FOLLOW CARECORE
                                                                                              CPT CODE                                                                                    CPT CODE
                                                                                                                    FOR 4TH                                                                                                                                   GUIDELINES **
                                                                                                                   SUBSEQU
                                                                                                                      ENT
                                                                                                                     SONO



                                                                                                                                                                                                                                           MEDLINK WILL CALL & MAKE THE APPOINTMENT FOR
                                                                 MEDLINK AUTH                                                                                                                                                                THE PAT/ONCE APPOITMENT IS CONFIRMED A MED
   MEDLINK PRIV & WC
                                                                 LETTER NEEDED                          NEED   NEED    NEED    NEED    NEED    NEED                                                                                          LINK REFERRAL WITH AUTH # WILL BE FAXED TO
      (THEY WILL                                                                  NEED TO     NEED                                                               NEED TO
                      ELIGIILITY                                THEY WILL FAXED                       MEDLINK MEDLINK MEDLINK MEDLINK MEDLINK MEDLINK   NEED                                                                                  DOSHI. WE ONLY CAN SEE PATIENT IF MEDLINK
     SCHEDULE THE                                                                CALL INS & MEDLINK                                                             CALL INS &
                       MUST BE                                  IT TO OUR OFFICE                       AUTH#   AUTH#   AUTH#   AUTH#   AUTH#   AUTH#   MEDLINK                                                       PRIV # 09110 WC #       FAXED OVER THEIR REFERRAL. IF REF DOCTOR IS
    APPOITMENT FOR                                                                VERIFY IF AUTH# SEE                                                            VERIFY IF
                     VERIFIED BY                                      WHEN                               SEE    SEE     SEE     SEE     SEE     SEE   AUTH# SEE                                                             09092           MAKING THE APPOIT WE CAN NOT SEE THE PATIENT
       THE PAT)                                                                    AUTH     COMMENT                                                               AUTH
                        PHONE                                   SCHEDULING THE                        COMMENT COMMEN COMMENT COMMEN COMMEN COMMEN COMMENTS                                                                                 WITHOUT GETTING REFERRAL & AUTH FROM MEDLINK
    MEDLINK PHONE                                                                 NEEDED        S                                                                NEEDED
                                                                APPOIT MENT FOR                           S      TS      S       TS      TS      TS                                                                                           . OTHERWISE MEDLINK WILL NOT PAY THE BILL. .
      800-335-5465
                                                                     THE PAT.                                                                                                                                                               FOR ALL MEDLINKS PATIENTS ATTACH DR # 20521 AS
                                                                                                                                                                                                                                                              REF DR# 2




                                                                MEDFOCUS AUTH
                                                                 LETTER NEEDED.
                                                                                                                                                                                                        NEED TO
                          ELIGIILITY                            THEY WILL FAXED
                                                                                   CALL           AUTH         AUTH        AUTH           AUTH           AUTH          AUTH       AUTH      AUTH       CALL INS &                            FOR MEDFOCUS ATTACH DR# 12697 AS REF DR # 2.
                           MUST BE                              IT TO OUR OFFICE
       MEDFOCUS WC                                                               HICKSVILL       LETTER       LETTER      LETTER         LETTER         LETTER        LETTER     LETTER    LETTER       VERIFY IF        WC # 09686           (MEDICAL REPORT NEEDS TO BE FAXED TO MED
                         VERIFIED BY                                  WHEN
                                                                                     E           NEEDED       NEEDED      NEEDED         NEEDED         NEEDED        NEEDED     NEEDED    NEEDED        AUTH                                                  FOCUS)
                            PHONE                               SCHEDULING THE
                                                                                                                                                                                                        NEEDED
                                                                APPOIT MENT FOR
                                                                     THE PAT.



                                                                MEDFOCUS AUTH
                                                                 LETTER NEEDED.
                                                                                                                                                                                                        NEED TO
                          ELIGIILITY                            THEY WILL FAXED
                                                                                   CALL           AUTH         AUTH        AUTH           AUTH           AUTH          AUTH       AUTH      AUTH       CALL INS &                          MEDFOCUS COMMERCIAL IS FOR DIFFERENT PAYERS
         MEDFOCUS          MUST BE                              IT TO OUR OFFICE
                                                                                 HICKSVILL       LETTER       LETTER      LETTER         LETTER         LETTER        LETTER     LETTER    LETTER       VERIFY IF   CLAIM CENTER # 09884    SUCH AS MULTIPLAN, HUMANA INS, ETC…. (MAKE
        COMMERCIAL       VERIFIED BY                                  WHEN
                                                                                     E           NEEDED       NEEDED      NEEDED         NEEDED         NEEDED        NEEDED     NEEDED    NEEDED        AUTH                                             SURE IS NOT WC)
                            PHONE                               SCHEDULING THE
                                                                                                                                                                                                        NEEDED
                                                                APPOIT MENT FOR
                                                                     THE PAT.


                                                                                                                                                                                                                                            MED SOLUTIONS WILL SCHEDULE WORKER COMP
                          ELIGIILITY
                                                                                      AUTH        AUTH         AUTH        AUTH           AUTH           AUTH          AUTH       AUTH      AUTH         AUTH                                 PATIENTS ON BEHALF OF THEIR PAYORS. & A
      MED SOLUTIONS        MUST BE                               MEDSOLUTION
                                                                                     LETTER      LETTER       LETTER      LETTER         LETTER         LETTER        LETTER     LETTER    LETTER       LETTER      CLAIM CENTER # 00086     MEDSOLUTION REFERRAL WILL BE FAXED . FOR
      WORKERS COMP       VERIFIED BY                              REFERRAL
                                                                                     NEEDED      NEEDED       NEEDED      NEEDED         NEEDED         NEEDED        NEEDED     NEEDED    NEEDED       NEEDED                             AUTHORIZATIONS CALL 1-888-693-3295 OR 3211 ** FOR
                            PHONE
                                                                                                                                                                                                                                                   PRIVATE SEE GREAT WEST INS***

                         INSURANCE                                                                                                                                                                      NEED TO
                           WEB SITE                                 DOCTOR                                                                                                                             CALL INS &
            METRO PLUS    PRINT OUT         www.metroplus.org      REFERRAL            YES          NO          NO           NO             NO             NO               NO     NO        NO         VERIFY IF          #02025
                         ELIGIBILITY                                NEEDED                                                                                                                               AUTH
                            FORM                                                                                                                                                                        NEEDED

                          ELIGIILITY                                                                                                                                                                                                         FOR DR. ROBERT BLACK, DR JOSE ACEVEDO, DR
                                                                    DOCTOR
                           MUST BE                                                                                                                                                                                   METRO MED BILL #          MICHAEL NEELY, DR BERRY KRASNER BILL
   METRO MEDICAL PC                                                REFERRAL                                    CONTRACTED TO DO MRI, CTS AND XRAYS ONLY/TABLE TIME
                         VERIFIED BY                                                                                                                                                                                      08862            CONTINENTAL ///////// FOR DR KENNETH JAMESON, DR
                                                                    NEEDED
                            PHONE                                                                                                                                                                                                               MARK LEVISON BILL METRO MEDICAL…




6/30/2010                                                                                                                 PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                       NPI DOSHI # 1720031339//Page 21
                                                                                                             Doshi Diagnostic Imaging Services of New York
                                                                        REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                              REF REQ                                                               AUTHORIZATION REQUIRED

                          INSURANCE WEB                                                                       CT SCAN &                                                                  NUCLEAR
                           SITE PRINT OUT                                         PET SCAN &                      CT                                                                    MEDICINE &       BREAST
        INSURANCE CO.                                         REFERRAL REQUIRED                  MRA & MRI                  SONO          MAMMO          X-RAYS                                                         CLAIM CENTER                            COMMENTS
                             ELIGIBILITY                                            PETCT                    ANGIOGRAPH                                                                  NUCLEAR         BIOPSY
                                FORM                                                                              Y                                                  VASCULAR           CARDIOLOGY
                                            WEBSITE ADDRESS                                                                                                          STUDIES     ECHO



                                                                                                                                                                                                                    PRI-CLAIM CENTER SEE
                                                                                                                                                                                                        NEED TO                          CALL ALICARE INS CO. TO FIND OUT IF THE MEMBER IS
                           ELIGIILITY                                                                                                                                                                                BACK OF THE CARD
                                                                  DOCTOR                         YES, ALL                                                                                              CALL INS &                             REPONSIBLE FOR ANY DEDUCTIBLE OR CO-
            MULTIPLAN       MUST BE                                                                                                                                                                                  ( USE NY NETWORK
                                                                 REFERRAL            YES          MRI's &       NO           NO             NO             NO               NO     NO       NO          VERIFY IF                           INSURANCE. IF MEMBER RESPONSIBLE PLEASE,
            (ALICARE)     VERIFIED BY                                                                                                                                                                               CLAIM CTR W(*NYNM)
                                                                  NEEDED                          MRAs                                                                                                   AUTH                            COLLECT THE MONEY . FOR PRE-CERTIFICATION CALL
                             PHONE                                                                                                                                                                                   SEC-BILL CLAIM CTR
                                                                                                                                                                                                        NEEDED                                     (800) 332-5426 OR (212) 539-51112
                                                                                                                                                                                                                       W/OUT (*NYNM)



                                                                                   YES , BY      YES , BY    YES , BY
        MULTIPLAN          ELIGIILITY
                                                                  DOCTOR           CALLING       CALLING     CALLING
     (AMALGAMATED           MUST BE                                                                                                                                                                                                           WSH-MP WASHABLE CLOTHING,SPORT WEAR AND
                                                                 REFERRAL          ALICARE       ALICARE     ALICARE         NO             NO             NO               NO     NO       NO            NO            CLAIM # 09454
    LIFE) GROUP WSH-      VERIFIED BY                                                                                                                                                                                                         ALLIED INDUSTRIES FUND :MULTIPLAN NETWORK
                                                                  NEEDED           800-543-      800-543-    800-543-
           MP                PHONE
                                                                                     4723          4723        4723

                                                                                                                                                                                         YES,ONLY
                                                                                                                                                                                                   NEED TO
                      ELIGIILITY                                                                                                                                                          STRESS                                            CALL AND GET AUTHORIZATION FOR ALL MRI'S, MRA'S,
                                                                  DOCTOR                         YES, ALL                                                                                         CALL INS &        CLAIM PRI BILL #09551
   MULTIPLAN BENEFIT   MUST BE                                                                               YES, ALL                                                                   THALLIUM                                             CT'S ,CARDIOLYTE AND STRESS THALLIUM. 800-220-
                                                                 REFERRAL            YES          MRIS &                     NO             NO             NO               NO     NO              VERIFY IF        W/NYNM*       AS SEC
       CONCEPTS      VERIFIED BY                                                                               CT's                                                                          &                                               2600.    PRE-CERTIFICATIONS MAY VARY BY PLAN
                                                                  NEEDED                          MRA'S                                                                                             AUTH                BILL # 02974
                        PHONE                                                                                                                                                           CARDIOLYT                                                         SPONSOR(CONTRACTS)
                                                                                                                                                                                                   NEEDED
                                                                                                                                                                                             E

    MUTIPLAN LOCAL
       107 LABOR
     MANAGEMENT             ELIG BY                               DOCTOR                                                                                                                                             PRI# 09328 (*NYNM)
      TRUST FUND          CALLING 718-                           REFERRAL            NO             NO          NO           NO             NO             NO               NO     NO       NO            NO         SEC# 03385 (W/OUT                    MUTIPLAN NETWORK
    *COLLECT COPAY          522-7272                              NEEDED                                                                                                                                                   NYNM)
    XRAY$10.00 MRIS$
          50.00

                                                                                                            YES,CALL
                                                                                   YES,CALL      YES,CALL
                                                                                                               THE                                                                       YES,CALL
                                                                                  THE LOCAL     THE LOCAL
                           ELIGIILITY                                                                       LOCAL TO                                                                    THE LOCAL
                                                                                  TO VERIFY     TO VERIFY
    MULTIPLAN LOCAL         MUST BE                               DOCTOR                                     VERIFY                                                                      TO VERIFY                     CLAIM PRI- 09521
                                                                                  WHETHER       WHETHER
    1964 HEALTH AND       VERIFIED BY                            REFERRAL                                   WHETHER          NO             NO             NO               NO     NO    WHETHER          NO        (*NYNM) SEC # 02510
                                                                                    AUTH IS       AUTH IS
    INSURANCE FUND        PHONE 201-                              NEEDED                                     AUTH IS                                                                      AUTH IS                       (W/OUT NYNM)
                                                                                   NEEDED        NEEDED
                            440-6523                                                                         NEEDED                                                                     NEEDED AT
                                                                                  AT 201-440-   AT 201-440-
                                                                                                            AT 201-440-                                                                 201-440-6523
                                                                                     6523          6523
                                                                                                               6523


                                                                                                                                                                                                                    PRI-CLAIM CENTER SEE
                                                                                                               AUTH                                                                                     NEED TO
                           ELIGIILITY                                                                                                                                                                                BACK OF THE CARD
                                                                  DOCTOR                         YES, ALL     NEEDED                                                                                   CALL INS &
            MULTIPLAN       MUST BE                                                                                                                                                                                  ( USE NY NETWORK        FOR PRE-CERTIFICATION CALL LOCAL 338 (718) 997-
                                                                 REFERRAL            YES          MRI's &    FOR DEXA        NO             NO             NO               NO     NO       NO          VERIFY IF
            (LOCAL 338)   VERIFIED BY                                                                                                                                                                               CLAIM CTR W(*NYNM)                           7400
                                                                  NEEDED                          MRAs         TEST                                                                                      AUTH
                             PHONE                                                                                                                                                                                   SEC-BILL CLAIM CTR
                                                                                                               ONLY                                                                                     NEEDED
                                                                                                                                                                                                                       W/OUT (*NYNM)


                                                                                                                                                                                                                    PRI-CLAIM CENTER SEE
                                                                                                               AUTH                                                                                     NEED TO
                           ELIGIILITY                                                                                                                                                                                BACK OF THE CARD
                                                                  DOCTOR                         YES, ALL     NEEDED                                                                                   CALL INS &
            MULTIPLAN       MUST BE                                                                                                                                                                                  ( USE NY NETWORK        FOR PRE-CERTIFICATION CALL LOCAL 338 (718) 997-
                                                                 REFERRAL            YES          MRI's &    FOR DEXA        NO             NO             NO               NO     NO       NO          VERIFY IF
            (LOCAL 338)   VERIFIED BY                                                                                                                                                                               CLAIM CTR W(*NYNM)                           7400
                                                                  NEEDED                          MRAs         TEST                                                                                      AUTH
                             PHONE                                                                                                                                                                                   SEC-BILL CLAIM CTR
                                                                                                               ONLY                                                                                     NEEDED
                                                                                                                                                                                                                       W/OUT (*NYNM)

                                                                                           CALL FOR CALL FOR
                                                                                            MRA'S &   ALL CT'S                                                                                            AUTH
                                                                                            MRI'S TO  TO FIND                                                                                           NEEDED
                                                                                           FIND OUT OUT IF WE                                                                                          DEPENDIN
                                                                                             IF WE   NEED PRE-                                                                                            G ON
                                                                                                                                                                                         CALL FOR                                       CALL INSURANCE COMPANY (TO FIND OUT IF THE
                                                                                           NEED PRE-   CERT/                                                                                           MEMBERS
                                                                                                                                                                                        CARDIOLYT                                           MEMBER IS RESPONSIBLE FOR ANY CO-
                                                                                             CERT/    PHONE #                                                                                           PLAN, OR PRI-CLAIM CENTER SEE
                                                                                                                                                                                        E & STRESS                                       INSURANCE,COPAYMENT OR DEDUCTIBLE). IF
                           ELIGIILITY                                             YES, BUT PHONE #    ON PAT'S                                                                                           LOCAL     BACK OF THE CARD
                                                                 DOCTORS                                                                                                                 TEST FIND                                       MEMBER RESPONSIBLE ,PLEASE COLLECT THE
     MULTIPLAN LOGO         MUST BE                                                IT MAY   ON PAT'S   CARD                                                                                              UNION     ( USE NY NETWORK
                                                                 REFERRAL                                                    NO              NO             NO              NO     NO    OUT IF WE                                     MONEY. WE NEED COPY OF THE INS CARD BACK &
     (ALL INS CARDS )     VERIFIED BY                                             VARY BY    CARD                                                                                                       NEED TO   CLAIM CTR W(*NYNM)
                                                                  NEEDED                                                                                                                 NEED PRE-                                     FRONT TO BILL THE INSURANCE CO. UNITED CRAFT
                             PHONE                                                  PLAN                                                                                                                CALL FOR   SEC-BILL CLAIM CTR
                                                                                                                                                                                           CERT/                                      INSURANCE NEED AUTHORIZATION FOR ANY CHARGE
                                                                                                                                                                                                          EACH       W/OUT (*NYNM)
                                                                                                                                                                                        PHONE # ON                                      OVER $200.00 / LOCAL 1500 IS PART OF BCBS AS OF
                                                                                                                                                                                                        UNION.. ,
                                                                                                                                                                                        PAT'S CARD                                                           1/1/07
                                                                                                                                                                                                       FOR LOCAL
                                                                                                                                                                                                        348 AUTH
                                                                                                                                                                                                         IS NOT
                                                                                                                                                                                                        NEEDED




6/30/2010                                                                                                                 PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                       NPI DOSHI # 1720031339//Page 22
                                                                                                         Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                             AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                     CT SCAN &                                                                    NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                    CT                                                                      MEDICINE &     BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                         CLAIM CENTER                          COMMENTS
                           ELIGIBILITY                                            PETCT                  ANGIOGRAPH                                                                    NUCLEAR       BIOPSY
                              FORM                                                                            Y                                                  VASCULAR             CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                        STUDIES     ECHO



                                                                                                         NO AUTH      NO AUTH       NO AUTH NO AUTH NO AUTH NO AUTH
                                                                                           NO AUTH       NEEDED       NEEDED        NEEDED NEEDED NEEDED NEEDED       NO AUTH
    NATIONAL HEALTH                                                                        NEEDED         ,,NEED       ,,NEED        ,,NEED  ,,NEED  ,,NEED  ,,NEED   NEEDED    NEED TO CLAIM CENTER # 05872
                        ELIGIILITY                             DOCTORS
  PLAN CORP LOGO FOR                                                              CALL      ,,NEED          NHP          NHP           NHP     NHP     NHP     NHP  ,,NEED NHP CALL INS & P.O BOX 2319, NY,NY
                         MUST BE                               REFERRAL                                                                                                                                                               NEED CLAIM FORM SIGNED BY MEMBER /// CALL FOR
   (LOCAL 295CND, 463,                                                          HICKSVILL NHP CLAIM       CLAIM        CLAIM         CLAIM   CLAIM   CLAIM   CLAIM     CLAIM    VERIFY IF  10116 (DO NOT SEND
                       VERIFIED BY                           NEEDED, NEED                                                                                                                                                                    MEMBER ELEGIBILITY (212) 279-3232
      T5418 & T5418                                                                 E        FORM          FORM         FORM          FORM    FORM    FORM    FORM     FORM      AUTH     CLAIMS TO ONE PENN
                          PHONE                               CLAIM FORM
         UNIONS                                                                           SIGNED BY       SIGNED       SIGNED        SIGNED  SIGNED  SIGNED  SIGNED SIGNED BY   NEEDED       PLAZA ADRESS)
                                                                                           MEMBER            BY           BY            BY      BY      BY      BY    MEMBER
                                                                                                         MEMBER       MEMBER        MEMBER MEMBER MEMBER MEMBER


                                                                                                             NEED TO          NEED TO NEED TO
                                                                                            NEED TO  NEED TO          NEED TO                                                 NEED TO  NEED TO
                                                                                 NEED TO                     COLLECT          COLLECT COLLECT                                                                                            DDIS HAS A CONTRACT WITH NAPP TO GIVE 30%
     NAPP * NATIONAL     ELIGIILITY                                                         COLLECT COLLECT           COLLECT                                                 COLLECT COLLECT
                                                               DOCTORS          CALL INS &                      70%             70%     70%                                                                      PATIENTS ARE SELF      DISCOUNT TO NAPP PATIENTS. OFFICES NEED TO
     ASSOCIATION OF       MUST BE                                                          70% FROM 70% FROM         70% FROM                                                70% FROM 70% FROM   CALL
                                                               REFERRAL          VERIFY IF                     FROM            FROM    FROM                                                                     PAY BILL CLAIM CTR#    COLLECT 70% OF OUR STANDARD FEE. . REMEMBER
        PREFERRED       VERIFIED BY                                                           OUR      OUR              OUR                                                     OUR      OUR   HICKSVILE
                                                                NEEDED            AUTH                          OUR             OUR     OUR                                                                            09878          THIS IS NOT A INSURANCE , THEREFORE PATIENTS ARE
      PROVIDERS PPO        PHONE                                                           STANDAR STANDAR           STANDAR                                                 STANDAR STANDARD
                                                                                 NEEDED                      STANDAR          STANDA STANDAR                                                                                                              SELF PAY.
                                                                                             D FEE    D FEE            D FEE                                                   D FEE     FEE
                                                                                                               D FEE           RD FEE  D FEE



                                                                                              FOR ALL                                                                                      FOR
                                                                                                                                                                                                                                    FOR COVERAGE VERIFICATION, MAILING ADDRESS
                                                                                              MRI'S &  FOR ALL                                                                        CARDIOLYT
                                                                                 NEED TO                                                                                                           NEED TO                            AND PRE-CERTIFICATION CALL THE 800 PHONE
       NATIONAL      ELIGIILITY                                                                 MRAS  CT'S CALL                                                                       E & STRESS
                                                               DOCTORS          CALL INS &                                                                                                        CALL INS &                      NUMBER ON EACH EMPLOYEE IDENTIFICATION CARD.
      PREFERRED       MUST BE                                                                   CALL    INS.CO                                                                         THALLIUM              SEE BACK OF THE CARD
                                                               REFERRAL          VERIFY IF                               NO             NO             NO               NO     NO                  VERIFY IF                          NPPN HAS DIFFERENT EMPLOYERS CONTRACTS,
   PROVIDER NETWORK VERIFIED BY                                                                INS.CO    (SEE                                                                          'S & CALL             FOR MAILING ADDRESS
                                                                NEEDED            AUTH                                                                                                              AUTH                          THEREFORE REQUIREMENTS MAY VARY. IF YOU HAVE
       NPPN PPO        PHONE                                                                    (SEE  COMMENT                                                                         INS.CO (SEE
                                                                                 NEEDED                                                                                                            NEEDED                          A PROBLEM VERIFYNG INFORMATION, CALL NPPN AT
                                                                                             COMMENT      S)                                                                          COMMENTS
                                                                                                                                                                                                                                                  800- 557 1656 EXT 40.
                                                                                                 S)                                                                                         )


                                                                                                                                                                                YES,
                                                                                    YES,         YES,        YES,    YES,                                                    EFFECTIV    YES,
                                                                                                                             FOR
                                                                                EFFECTIVE    EFFECTIVE   EFFECTIVE (ONLY                                                          E   EFFECTIVE                                          EFFECTIVE IMMEDIATELY AUTHORIZATION IS
                         ELIGIILITY                                                                                        ROUTINE
                                                               DOCTORS          IMMEDIAT     IMMEDIAT    IMMEDIAT     OB                                                     IMMEDIA IMMEDIATE                                         NEEDED FOR ALL PLANS // NEIGHBORHOOD DON'T
                          MUST BE                                                                                          MAMMO
      NEIGHBORHOOD
                        VERIFIED BY
                                          WWW.MYNHP.COM        REFERRAL         ELY AUTH     ELY AUTH    ELY AUTH SONOS &
                                                                                                                             SEE
                                                                                                                                                       NO               NO      TELY  LY AUTH IS      NO         CLAIM CTR # 09986        COVER (ROUTINE )-SCREENING MAMMO FOR
                                                                NEEDED          IS NEEDED    IS NEEDED   IS NEEDED    OB                                                      AUTH IS  NEEDED                                         PATIENTS UNDER 40 YRS OLD. AND WE CAN NOT BILL
                           PHONE                                                                                          COMMENT
                                                                                 FOR ALL      FOR ALL     FOR ALL TRASVAG                                                     NEEDED   FOR ALL                                          THE PATIENT / FOR AUTH# CALL 800- 765 3805
                                                                                                                              S
                                                                                  PLANS        PLANS       PLANS    INAL)                                                    FOR ALL    PLANS
                                                                                                                                                                               PLANS


                                                                                 NEED TO                                                                                                            NEED TO
                    ELIGIILITY
  NEW ENGLAND WITH                                              DOCTOR          CALL INS &                                                                                                         CALL INS &     BILL CLAIMS TO
                     MUST BE
   ONE HEALTH PLAN                                             REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO        NO         VERIFY IF    ADDRESS ON THE           ENTER NEW ENGLAND IN THE GROUP FIELD
                   VERIFIED BY
        LOGO                                                    NEEDED            AUTH                                                                                                               AUTH       MEMBER'S ID CARD
                      PHONE
                                                                                 NEEDED                                                                                                             NEEDED



                                                                                 NEED TO                                                                                                            NEED TO
                   ELIGIBILITY
                                                                DOCTOR          CALL INS &                                                                                                         CALL INS &     BILL CLAIMS TO
  NEW ENGLAND WITH  MUST BE
                                                               REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO        NO         VERIFY IF    ADDRESS ON THE
   MULTIPLAN LOGO  VERIFIED BY
                                                                NEEDED            AUTH                                                                                                               AUTH       MEMBER'S ID CARD
                     PHONE
                                                                                 NEEDED                                                                                                             NEEDED




    NORTH AMERICAN      ELIGIBILITY                             DOCTOR           YES, CALL YES, CALL YES, CALL                                                                         YES, CALL YES, CALL
    PLANS (QUALCARE     BY CALLING                             REFERRAL         INS AT 800- INS AT 800- INS AT 800-      NO             NO             NO               NO            INS AT 800- INS AT 800-       PLAN# 02228               P.O BOX 1030, PISCATAWAY,NJ 08855
         LOGO)          800-397-2122                            NEEDED            397-2122    397-2122   397-2122                                                                       397-2122    397-2122




                                                                                                                                                                                                                                        1.ALL N/F PAPERS MUSTBE SIGNED BY PATIENT    2.
                                                                                                                                                                                                                                                  DATE OF ACCIDENT IS A MUST.
                                                                                                                                                                                                                                       3. ATTORNEY'S PHONE # AND ADDRESS. 4..FOR MRIS
                                                                                                                                                                                                                                               NEED LETTER OF MEDICAL NECESSITY.
                          COLLECT                                                                                                                                                                                                          5.ASSIGNMENT SHEET SIGNED AND FILLED BY
                                                                DOCTORS
                        COMPLETE NF                                             PET SCAN                                                                                                                                                     PATIENT & DATED. 6.LIEN SHEET SIGNED.
                                                             REFERRAL AND
                            AUTO                                                ARE NOT                                                                                                                                                     7.MVA APPLICATION (NF-2)    8. NO FAULT
            NO-FAULT                                         LETTER OF MED.                     NO          NO           NO              NO             NO              NO     NO        NO           NO         CLAIM CTR: # 00048
                         INSURANCE                                               ORDER                                                                                                                                                 INSURANCE CARRIER INFORMATION ADDRESS &
                                                               NECESSITY
                           INF/SEE                                               FOR NF                                                                                                                                                PHONE NUMBER 9. POLICY #NUMBER & POLICY
                                                                NEEDED
                         COMMENTS                                                                                                                                                                                                          HOLDER *** FILING TIME FOR NF CASES IS 30
                                                                                                                                                                                                                                      DAYS**From DOS MRI OF THE LS SPINE CAN BE DONE
                                                                                                                                                                                                                                          ONLY 30 DAYS AFTER THE DATE OF ACCIDENT..
                                                                                                                                                                                                                                        (CHIROPRACTORS CAN ONLY REFER PATIENTS FOR
                                                                                                                                                                                                                                                    SPINE RELATED INJURIES).

6/30/2010                                                                                                             PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                     NPI DOSHI # 1720031339//Page 23
                                                                                                                 Doshi Diagnostic Imaging Services of New York
                                                                              REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                    REF REQ                                                             AUTHORIZATION REQUIRED

                           INSURANCE WEB                                                                          CT SCAN &                                                                      NUCLEAR
                            SITE PRINT OUT                                              PET SCAN &                    CT                                                                        MEDICINE &      BREAST
        INSURANCE CO.                                               REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                            CLAIM CENTER                            COMMENTS
                              ELIGIBILITY                                                 PETCT                  ANGIOGRAPH                                                                      NUCLEAR        BIOPSY
                                 FORM                                                                                 Y                                                  VASCULAR               CARDIOLOGY
                                              WEBSITE ADDRESS                                                                                                            STUDIES     ECHO
                                                                     DOCTOR AUTH
                            ELIGIILITY
                                                                    LETTER FROM NY
        NY CITY FIRE         MUST BE
                                                                        CITY FIRE                          CONTRACTED TO DO MRI ONLY (BRAIN AND SKULL $470) (ALL OTHERS $ 410)                                             CLAIM CENTER# 04812
        DEPARTMENT         VERIFIED BY
                                                                      DEPARTMENT
                              PHONE
                                                                       PHYSICIAN


                                                                                                                                                                                                                                                   THEY HAVE THREE PRODUCUTS. CHILD HEALTH PLUS
   NY PRESBYTERIAN    ELIGIILITY                                                                                            NO ,                                                                                                                   ,FAMILY HEALTH PLUS, AND T MEDICAID plan .// PLAN
                                                                        DOCTOR             NO ,       NO ,       NO ,                                                                              NO ,
  COMMUNITY HEALTH     MUST BE                                                                                           EFFECTIV                                                                                                                     CODE ON MEDICAID UT STRIP IS "NW". CLAIM &
                                                                       REFERRAL         EFFECTIVE EFFECTIVE EFFECTIVE                           NO             NO               NO     NO       EFFECTIVE        NO           CLM CTR# 08249
   PLAN* (UT INS COV VERIFIED BY                                                                                             E                                                                                                                       ELIGIBILITY PH# 1- 888-275-0929 AS OF 4/27/2007
                                                                        NEEDED          04/27/2007 04/27/2007 04/27/2007                                                                        04/27/2007
      CODE "NW")        PHONE                                                                                            04/27/2007                                                                                                                 AUTH IS NO LONGER REQ../// FOR AUTHORIZATION
                                                                                                                                                                                                                                                                  CALL 1-866-826-6653



     OCCUPATIONAL                                                   OCCUPATIONAL H
    HEALTH SERVICES                                                    SERVICES
                                                                                                                              CONTRACTED TO DO ONLY CHEST X-RAY                                                                CLAIM#08322
      797 UNION ST                                                     REFERRAL
   BROOKLYN NY 11215                                                    NEEDED

  OXFORD (CARE CORE)                                                                                                    YES, OB                                                                  YES, ALL
  FREEDOM / LIBERTY/                                                                                                     SONO-                                                                   NUCLEAR
                                                                                                                                                                                                                          90000'S SERIES BILL-#
    HMO /& MEDICARE                                                                                                      76801-                                                                 MEDICINE
                                                                                                                                                                                                                         02509 (NEED OXF REF).
      ADVANTAGE.                                                                                                         76811                                                                  NEED PRE-
                                                                                                                                                                                                                          70000,S & CONTRAST
     AUTHORIZATION                                                                                                        ANY                                                                      CERT
                                                                                                                                                                                                                         UNDER $50. BILL # 09626
    NEEDED FOR PRI &                                                                                                     AFTER                                                                      FOR
                                                                                                                                                                                                                          FOR 58340 INJECTION
   SEC          (OXF                                                                                                      THE                                                                   CADIOLITE                                           CALL CARECORE FOR AUTH AT 877-773-2884. THE
                     INSURANCE                                                                                                                                                                                              BILL #2509   FOR
       MEDICARE                                                                                                          THIRD                                                                  TEST NEED                                            REFERRING PHYSICIAN MUST OBTAIN THE PRE-
                       WEB SITE                                                                                                                                                                                            A9500,A9505, A4646,
   ADVANTAGE-NEW                                                                                                          ONE                                                                   PRE- CERT                                           CERFICATION. IF PATIENT IS HAVING MORE THAN
                      PRINT OUT                                                                                                                 NO                                                                        BILL # 09626    J0152
     LOGO SECURE                                                                                                         DONE                                                                   FOR 78465 ,                                        ONE TEST THAT NEED PRE-CERT ON THE SAME DAY,
                     ELIGIBILITY                                                                                                                                                                                            ADENOSINE- BILL
       HORIZON)                                                                                                           AND                                                                     78478 &                                           PLEASE GET AUTH FOR EACH ONE.( PRE-CERT ARE
                        FORM                                         NEED OXFORD                                                                                                                                             #02509     FOR
                                                FOR ELIGIBILITY                                       YES, ALL           76817                                                                     78480.                                                     GOOD FOR 45 DAYS ONLY.
                                                                      ELECTRONIC                                                                                                                                         ISOTOPES(A4641) AND
                                             WWW.OXFORDHEALTH.CO                                       MRI's & YES, ALL TRANSV                                                                                            GADOLINIUM OVER $
                                                                    REFERRAL # FOR                                         OB
                                                       M                                             MRAs AND     CT's                                                                                        NO AUTH IS 50.00 # 09593 OXFORD
                                                                    ALL 90000 SERIES       YES                                                                 NO               NO     NO
                                                  FOR AUTH                                           GADOLLINI EXCEPT                                                                                          NEEDED        AS SEC# 09593
                                                                     ONLY FOR THE
                                             WWW.CARECORENATIONA                                         UN      DEXA                                                                                                        APPEALS# 09592
                                                                     FREEDOM HMO
                                                    L.COM                                            INJECTION
                                                                         PLAN

                                                                                                                                           SCREENIN
                                                                                                                                               G
                                                                                                                                           (ROUTINE)                                                                                                BAYRIDGE OFFICE CAN NOT DO MRI'S . & MRAS
                                                                                                                                            MAMMO                                                                           OXFORD WITH FIRST       FOR CARECORE // RVC OFFICE CAN NOT SEE
                                                                                                                                              NOT                                                                            HEALTH LOGO USE         ANY PATIENT FOR CARE CORE// PELHAM BAY
                                                                                                                                             COVER                                                                           CLAIM CTR # 08619      OFFICE IS NOT CREDENTIAL TO PERFORM PET
                                                                                                                                            UNDER 34                                                                                                       SCANS STUDIES FOR CARECORE
                                                                                                                                             YRS OF
                                                                                                                                              AGE


                           INSURANCE
       OXFORD                WEB SITE                               CMO MONTEFIORE       YES, REF    YES, REF    YES, REF     YES, REF      YES, REF       YES, REF YES, REF         YES, REF    YES, REF      YES, REF
   CMO-MONTEFIORE           PRINT OUT                               REFERRAL              AUTH        AUTH        AUTH         AUTH          AUTH           AUTH     AUTH             AUTH        AUTH          AUTH          CLAIM # 08122
   LOGO ON THE CARD        ELIGIBILITY                              NEEDED               NUMBER      NUMBER      NUMBER       NUMBER        NUMBER         NUMBER NUMBER             NUMBER      NUMBER        NUMBER
                              FORM

                                               FOR ELIGIBILITY
                                             WWW.OXFORDHEALTH.C
                                                     OM                                   YES,     YES,     YES,     YES,     YES,                           YES,          YES,        YES,               YES,
                                                                                                                                                                                                 YES,
                           INSURANCE                                                    DEPENDS DEPENDS DEPENDS DEPENDS DEPENDS                            DEPENDS       DEPENDS     DEPENDS            DEPENDS
                                                                                                                                                                                               DEPENDS
        OXFORD               WEB SITE                                   DOCTOR             ON       ON       ON       ON       ON                             ON            ON          ON                 ON                                      YES, AUTHORIZATION IS NEEDED AND DEPENDS ON
                                                                                                                                                                                                  ON                        CLAIM CENTER# 02509
  FIRST HEALTH LOGO         PRINT OUT                                  REFERRAL          MEMBER  MEMBER MEMBER MEMBER MEMBER                               MEMBER        MEMBER      MEMBER              MEMBER                                    TYPE OF PLAN.. NEED TO CALL 1-800-666-1353 FOR
                                                                                                                                                                                               MEMBER                      (BILL OXFORD DIRECT)
         CARDS             ELIGIBILITY                                  NEEDED          PLAN,SEE PLAN,SEE PLAN,SEE PLAN,SEE PLAN,SEE                       PLAN,SEE      PLAN,SEE    PLAN,SEE           PLAN,SEE                                                   ALL PATIENTS.
                                                                                                                                                                                               PLAN,SEE
                              FORM                                                      COMMENT COMMENT COMMENT COMMEN COMMENT                             COMMEN        COMMEN      COMMEN             COMMENT
                                                                                                                                                                                              COMMENTS
                                                                                            S        S        S       TS        S                             TS            TS          TS                  S



                                                                     NEED OXFORD
                           INSURANCE
     OXFORD (DIRECT)                                                  ELECTRONIC
                             WEB SITE
    FREEDOM, LIBERTY,                           FOR ELIGIBILITY     REFERRAL # FOR
                            PRINT OUT                                                                                   NEED ELECTRONIC REFERRAL FOR ALL 90000 SERIES                                                         CLAIM # 02509
     HMO & MEDICARE                          WWW.OXFORDHEALTH.COM   ALL 90000 SERIES
                           ELIGIBILITY
    ADV(secure Horizons)                                                FOR ALL
                              FORM
                                                                     PROCEDURES


                                                                                         NEED TO                                                                                                               NEED TO
                            ELIGIILITY
                                                                                        CALL INS &     AUTH        AUTH        AUTH           AUTH           AUTH          AUTH       AUTH        AUTH        CALL INS &
    ONE CALL MEDICAL         MUST BE                                 ONE CALL AUTH                                                                                                                                                                 FOR ALL ONE CALL MEDICAL PATIENTS ATTACH DR#
                                                                                         VERIFY IF    LETTER      LETTER      LETTER         LETTER         LETTER        LETTER     LETTER      LETTER        VERIFY IF        WC # 4167
           WC              VERIFIED BY                               LETTER NEEDED                                                                                                                                                                              21238 AS REF DR #2. O
                                                                                          AUTH        NEEDED      NEEDED      NEEDED         NEEDED         NEEDED        NEEDED     NEEDED      NEEDED         AUTH
                              PHONE
                                                                                         NEEDED                                                                                                                NEEDED

6/30/2010                                                                                                                     PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                          NPI DOSHI # 1720031339//Page 24
                                                                                                          Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                                AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                     CT SCAN &                                                                     NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                    CT                                                                       MEDICINE &     BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                     SONO          MAMMO          X-RAYS                                                        CLAIM CENTER                            COMMENTS
                           ELIGIBILITY                                            PETCT                  ANGIOGRAPH                                                                     NUCLEAR       BIOPSY
                              FORM                                                                            Y                                                     VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                           STUDIES     ECHO

                         ELIGIILITY
                                                               DOCTORS
                          MUST BE                                                                                                                                                                                                         CALL NUMBER ON THE CARD FOR DISCOUNT PRICE $
            SELF PAY                                           REFERRAL                            THIS IS A DISCOUNT PLAN* PT ARE SELF PAY * NEED TO COLLECT THE MONEY*                                         CLAIM SELF PAY #00 731
                        VERIFIED BY                                                                                                                                                                                                                866 -547-1600 -REPRICING UNIT
                                                                NEEDED
                           PHONE

                                                                                 NEED TO                                                                                                             NEED TO
        PARTNER           ELIGIILITY
                                                               DOCTORS          CALL INS &                                                                                                          CALL INS &       BILL CLAIMS TO
    ADMINISTRATIVE         MUST BE
                                                               REFERRAL          VERIFY IF       NO          NO             NO             NO             NO               NO     NO       NO        VERIFY IF      ADDRESS ON THE
  SERVICES PPO / fomerly VERIFIED BY
                                                                NEEDED            AUTH                                                                                                                AUTH         MEMBER'S ID CARD
    Lawrence Healthcare     PHONE
                                                                                 NEEDED                                                                                                              NEEDED

  PARTNERS IN HEALTH
                      ELIGIILITY
     AKS *     ST                                              DOCTORS            RIGHT NOW * PELHAM BAY OFFICE IS CONTRACTED TO DO OPEN MRI ONLY FOR ST BARNABAS INSURANCE***
                       MUST BE
    BARNABAS - INS                                             REFERRAL              OTHER LOCATIONS ARE NOT CONTRACTED TO ANY TEST. AUTHORIZATION IS NEEDED FOR MRIS' NEED                                      CLAIM CENTER# 0 2819          FOR AUTHORIZATION CALL 718-960-9298
                     VERIFIED BY
    COV CODE "SC" *                                             NEEDED                                           AUTHORIZATION* FOR ALL MRAS & MRIS
                        PHONE
   SEE COMMENTS**

                         ELIGIILITY
    PLATINUM HEALTH                                            DOCTORS
                          MUST BE
      PLUS IS NOT A                                            REFERRAL                            THIS IS A DISCOUNT PLAN* PT ARE SELF PAY * NEED TO COLLECT THE MONEY*                                         CLAIM SELF PAY # 00731   CALL NUMBER ON THE CARD FOR DISCOUNT PRICE$
                        VERIFIED BY
       INSURANCE                                                NEEDED
                           PHONE

                                                                                                                                                                                                                                            CALL INSURANCE COMPANY (TO FIND OUT IF THE
                                                                                                                                                                                                                                                MEMBER IS RESPONSIBLE FOR ANY CO-
                                                                                 NEED TO                                                                                                             NEED TO                                 INSURANCE,COPAYMENT OR DEDUCTIBLE). IF
                         ELIGIILITY                                                                                                                                                                               PRI-BILL CLAIM CTR
        PHCS LOGO                                              DOCTORS          CALL INS &                                                                                                          CALL INS &                               MEMBER RESPONSIBLE ,PLEASE COLLECT THE
                          MUST BE                                                                                                                                                                                     W(*NYNM)
      (ALL INSURANCE                                           REFERRAL          VERIFY IF       NO          NO             NO             NO             NO               NO     NO       NO        VERIFY IF                             MONEY. WE NEED COPY OF THE INS CARD BACK &
                        VERIFIED BY                                                                                                                                                                               SEC-BILL CLAIM CTR
          CARDS)                                                NEEDED            AUTH                                                                                                                AUTH                                        FRONT TO BILL THE INSURANCE CO.
                           PHONE                                                                                                                                                                                    W/OUT (*NYNM)
                                                                                 NEEDED                                                                                                              NEEDED                               FOR ANY CARD SHOWING PHCS LOGO BILL NEW YORK
                                                                                                                                                                                                                                           NETWORK CLAIM CENTERS W/(*NYNM), EXCEPT FOR
                                                                                                                                                                                                                                               GREAT WEST & NEW ENGLAND INSURANCE


                                                                                 NEED TO      NEED TO      NEED TO                                                                       NEED TO      NEED TO
                                                                                CALL INS & CALL INS & CALL INS &                                                                        CALL INS &   CALL INS & PLAN CODE PRI # 20014
                         ELIGIBLITY                             DOCTOR           VERIFY IF    VERIFY IF    VERIFY IF                                                                     VERIFY IF    VERIFY IF
       PREMIER CLUB                                                                                                                                                                                              *(NYNM) SEC#PLAN
                        BY CALLING 1-                          REFERRAL            AUTH         AUTH         AUTH           NO             NO             NO               NO              AUTH         AUTH
      BENEFITS (PHCS)                                                           NEEDED BY NEEDED BY NEEDED BY                                                                           NEEDED BY NEEDED BY       CODE #31000 (w/.out
                         888-532-3467                           NEEDED
                                                                                CALLING 800- CALLING 800- CALLING 800-                                                                 CALLING 800- CALLING 800-        nynm)
                                                                                  874-2378     874-2378     874-2378                                                                      874-2378     874-2378




                                                                            NEED TO                                                                                                                                                       CALL PRN REPRESENTATIVE AT (212) 631-0630 TO GET
                    ELIGIILITY                                                           PRN      PRN     PRN      PRN     PRN     PRN     PRN
                                                                  PRN      CALL INS &                                                                PRN                                                                                  THE CONFIRMATION FORM FAX TO DOSHI. THIS WILL
   PRN    PRIMARY    MUST BE                                                          CONFIRMA CONFIRMA CONFIRM CONFIRMA CONFIRM CONFIRM CONFIRM                                                                 CLAIM CENTER # 09438
                                                            CONFIRMATION/A VERIFY IF                                                             CONFIRMAT                                                                                SERVE AS AUTHORIZATION . ENTER DR # 1489 AS REF
  RESOURCE NETWORK VERIFIED BY                                                          TION     TION    ATION    TION    ATION   ATION   ATION                                                                          WC
                                                               UTH FORM      AUTH                                                                 ION FORM                                                                                     DR #2 . DO NOT BILL CLAIMANT'S PRIMARY
                      PHONE                                                             FORM     FORM    FORM     FORM    FORM    FORM    FORM
                                                                            NEEDED                                                                                                                                                          INSURANCE. PRN IS RESPONSABLE FOR PAYMENT.




                                                                                 NEED TO                      NEED             NEED    NEED    NEED                                              NEED TO                         RAYTEL MUST BE BILLED DIRECTLY FOR ANY PAT
                         ELIGIILITY                                                          NEED     NEED             NEED                                                              NEED              CLAIM CENTER FOR ALL
                                                              NEED RAYTEL       CALL INS &                   RAYTEL           RAYTEL RAYTEL RAYTEL                                              CALL INS &                      THAT THEY REFER TO US, REGARDLESS OF THE PAT'S
     RAYTEL IMAGING       MUST BE                                                           RAYTEL   RAYTEL           RAYTEL                                                            RAYTEL               OFFICES      PRIV
                                                                 IMAG.           VERIFY IF                    IMAG.            IMAG.   IMAG.   IMAG.                                             VERIFY IF                          INSURANCE OR IF WC CASE.. NEED RAYTEL
        NETWORK         VERIFIED BY                                                          IMAG.    IMAG.            IMAG.                                                             IMAG.                     #05543
                                                               REFERRAL           AUTH                       REFERRA          REFERRA REFERRA REFERRA                                             AUTH                          AUTHORIZATION REFERRAL. .. ENTER DOCTOR # 21048
                           PHONE                                                           REFERRAL REFERRAL         REFERRAL                                                          REFERRAL                  WC#01244
                                                                                 NEEDED                         L                L       L       L                                               NEEDED                                          AS REF DR#2



                                                                                 NEED TO                                                                                                             NEED TO
                         ELIGIILITY                                                                                                                                                                            IF SIU LOGO BILL#-05165
                                                                                CALL INS &                                                                                                          CALL INS &
   SEAFARERS HEALTH       MUST BE                                                                                                                                                                              DIRECT WITH DDIS TAX
                                                                                 VERIFY IF       NO          NO             NO             NO             NO               NO     NO       NO        VERIFY IF
     & BENEFIT PLAN     VERIFIED BY                                                                                                                                                                              IF NMU LOGO BILL#0-
                                                                                  AUTH                                                                                                                AUTH
                           PHONE                                                                                                                                                                                     8199 W*NYNM)
                                                                                 NEEDED                                                                                                              NEEDED
                                                                                 NEED TO                                                                                                             NEED TO
                         ELIGIILITY                                                                                                                                                                                                  FOR W.JONES EMPLOYER (DICKARD WIDDEN, LOCAL
                                                                DOCTOR          CALL INS &                                                                                                          CALL INS & CLAIM CENTER FOR ALL
       SELECT PRO /WJ     MUST BE                                                                                                                                                                                                      413 CLAIMS GO TO SHALIK MORRIS /CO LLP 7001
                                                               REFERRAL          VERIFY IF       NO          NO             NO             NO             NO               NO     NO       NO        VERIFY IF   OFFICES #05526 SEE
           JONES        VERIFIED BY                                                                                                                                                                                                 BRUSH HOLLOW RD, CLAIM CRT # 2584 (516) 3388700 AS
                                                                NEEDED            AUTH                                                                                                                AUTH          COMMENTS
                           PHONE                                                                                                                                                                                                                        OF 8/1//99
                                                                                 NEEDED                                                                                                              NEEDED

    SCREEN ACTORS     ELIGIILITY
                                                                DOCTOR
   GUILD-PRODUCERS     MUST BE                                                                                                                                                                                    PRI- 09553 (*NYNMZ0
                                                               REFERRAL             NO           NO          NO             NO             NO             NO               NO     NO       NO          NO                                           SAG 800-777-4013- 818-954-9400
  HEALTH PLAN (PHCS) VERIFIED BY                                                                                                                                                                                        SEC 02937
                                                                NEEDED
         SAG            PHONE




6/30/2010                                                                                                                PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                      NPI DOSHI # 1720031339//Page 25
                                                                                                              Doshi Diagnostic Imaging Services of New York
                                                                          REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                REF REQ                                                              AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                          CT SCAN &                                                                    NUCLEAR
                         SITE PRINT OUT                                             PET SCAN &                     CT                                                                      MEDICINE &     BREAST
        INSURANCE CO.                                           REFERRAL REQUIRED                MRA & MRI                   SONO          MAMMO          X-RAYS                                                          CLAIM CENTER                               COMMENTS
                           ELIGIBILITY                                                PETCT                   ANGIOGRAPH                                                                    NUCLEAR       BIOPSY
                              FORM                                                                                 Y                                                  VASCULAR             CARDIOLOGY
                                           WEBSITE ADDRESS                                                                                                            STUDIES     ECHO




                                                                                     NEED TO                                                                                                                     FOR TRANSCION MEDICAL PC ENTER DR# 34124 AS
                                                                                    CALL INS & CONTRACTED TO DO ALL PROCEDURE FOR PRIV INSURANCES, WC, NF (DO NOT BILL TO THE PAT'S INS)                        REF DR #2. FAX MEDICAL REPORT TO (315) 446-3338 .
        TRANSCION                                                 TRANSCION                                                                                                              CLAIM CENTER # PRIV -0
                                                                                     VERIFY IF  TRANSION WILL CONTACT OUR FACILITY TO MAKE APPOITMENT.. SERVICES CAN NOT BE PERFORMED                           CALL TRANSCION AT 315-446-3334 TO CONFIRM OR
        MEDICAL P.C                                              CONFIRMATION                                                                                                               5099 WC- 02123
                                                                                      AUTH                      WITHOUT TRANSCION'S WRITTEN PRE-APROVAL AUTH LETTER.                                            TO GET AUTH OR TO NOTIFY SCHEDULE CHANGES OR
                                                                                     NEEDED                                                                                                                                       NO SHOWS .




                                                                                     NEED TO
                         ELIGIILITY                                                                                                                                                                                                           FOR HEALTH TECH PATIENTS ENTER DR# 23206 AS REF
                                                                  TECH HEALTH       CALL INS &     AUTH         AUTH        AUTH           AUTH           AUTH          AUTH       AUTH      AUTH
                          MUST BE                                                                                                                                                                                                               DR #2. . CALL TECH HEALTH AT 813- 248-3788 TO
     TECH-HEALTH INC                                              AUTH LETTER        VERIFY IF    LETTER       LETTER      LETTER         LETTER         LETTER        LETTER     LETTER    LETTER                         WC # 3878
                        VERIFIED BY                                                                                                                                                                                                            CONFIRM OR TO GET AUTH OR TO NOTIFY SCHEDULE
                                                                    NEEDED            AUTH        NEEDED       NEEDED      NEEDED         NEEDED         NEEDED        NEEDED     NEEDED    NEEDED
                           PHONE                                                                                                                                                                                                                           CHANGES OR NO SHOWS .
                                                                                     NEEDED




                    INSURANCE
     TRICARE (US                                                                                                                                                                                                        as 9/1/04 PRI/SEC #
                      WEB SITE                                                                                                                                                                                                                AS OF 9/1/04 TRICARE NAME IS HEALTH NET FEDERAL
  ARMY)      HEALTH                                                DOCTORS                       YES/ MRI's                                                                                                           04860     (BILL # 01497
                     PRINT OUT             WWW.MYTRICARE.COM                           YES                       NO           NO             NO             NO               NO     NO        NO           NO                                 SERVICES, BUT IS NOT PART OF CARE CORE. CALL FOR
     NET FEDERAL                                                REFERAL NEEDED                    & MRA's                                                                                                            (ONLY FOR SEC / MCR
                    ELIGIBILITY                                                                                                                                                                                                                AUTHO FOR MRA'S & MRI'S & PET SCAN 877-874-2273
      SERVICES                                                                                                                                                                                                           SUPPLEMENT )
                       FORM




                                                                               YES, THRU YES, THRU YES, THRU                                                                                                           BILL MED SOL FOR
                                                                                 MED       MED       MED                                                                                                             PET,MRA,MRI,CT # 30093
                        CHECK ELIG                                             SOLUTION SOLUTION SOLUTION                                                                                                               / FOR ALL OTHER     AS OF 7/1/07 DDIS IS PARTICIPATING WITH TRUSTMARK
      TRUSTMARK LIFE                      www.medsolutions.co      DOCTORS
                        BY CALLING                                                 BY        BY        BY                     NO             NO             NO               NO     NO        NO           NO              STUDIES BILL      /MEDSOLUTIONS . ///// Pet Scans, Mra;s ,Mris, & CT's need
      INSURANCE PPO                              m              REFERAL NEEDED
                        888-693-3211                                            CALLING   CALLING   CALLING                                                                                                             TRUSTMARK INS                    auth from Med Solutions as of 6/1/07
                                                                                888-693-  888-693-  888-693-                                                                                                             DIRECT ADD ON
                                                                                  3211      3211      3211                                                                                                            CARD(W/OUT NYNM)



                                                                                                                                                                                                                                                 TOUCHTONE 888-777-0350 OR 888-77-70263. FOR
                                                                                                                                                                                                                                                TOUCHTONE PATIENTS WITH ID #100001106 BILL
                                                                                                                                                                                             YES ALL                   # BILL 30009 ( FOR
                         ELIGIILITY                                                                                                                                                                                                            PLAN# 30009 (PAT WITH THIS ID # ARE NOT PART OF
                                                                                                 YES, ALL     YES / ALL                                                                     NUCLEAR                  HEALTHNET *SMART
        TOUCHSTONE        MUST BE                                  DOCTORS                                                                                                                                                                      HEALTHNET. /// FOR HEALTH NET PATIENTS 8SEE
                                                                                       YES        MRI's &     CT'S AND        NO             NO             NO               NO    YES     CARDIOLOG       NO         CHOICE PATIENTS
        HEALTH PSO      VERIFIED BY                             REFERAL NEEDED                                                                                                                                                                 HEALTHNET/TOUCHTONE*****          .AS OF 1/1/06 NO
                                                                                                  MRAs         DEXA                                                                         Y , MUGA,                    SEE* HEALTH
                           PHONE                                                                                                                                                                                                               INS REFFERAL IS NEEDED .... MANHATTAN OFFICES
                                                                                                                                                                                                ECG                   NET/TOUCHTONE)
                                                                                                                                                                                                                                                CAN NOT TAKE SMART CHOICE PATIENTS- CLAIMS
                                                                                                                                                                                                                                                       WILL BE PROCESS OUT NETWORK*




                                                                                     NEED TO                                                                                                             NEED TO
                         ELIGIILITY                                                                                                                                                                                FOR CLAIM CENTER SEE
          UNICARE                                                                   CALL INS &                                                                                                          CALL INS &
                          MUST BE                                  DOCTORS                                                                                                                                              BACK OF THE
       (BEECH STREET                                                                 VERIFY IF      NO           NO           NO             NO             NO               NO     NO        NO         VERIFY IF
                        VERIFIED BY                             REFERAL NEEDED                                                                                                                                      CARD/BEECH STREET
           CORP)                                                                      AUTH                                                                                                                AUTH
                           PHONE                                                                                                                                                                                          ADDR.
                                                                                     NEEDED                                                                                                              NEEDED




   UNITED DIAGNOSTIC
                                                                  UNITED DIAG
   IMAGING PC (NF &                                                                                            CONTRACTED TO DO MRI'S , MRA'S , CTS & XRAYS                                                                  # 02962
                                                                REFERAL NEEDED
       PRIV INS)



                                                                                     NEED TO                                                                                                             NEED TO
    UNITED FURNITURE     ELIGIILITY
                                                                                    CALL INS &                                                                                                          CALL INS &   CLAIM CENTER # 08369
        WORKERS           MUST BE                                  DOCTORS
                                                                                     VERIFY IF      NO           NO           NO             NO             NO               NO     NO        NO         VERIFY IF   (*NYNM) MULTIPLAN                              615-889-8860
    INSURANCE FUND -    VERIFIED BY                             REFERAL NEEDED
                                                                                      AUTH                                                                                                                AUTH            NETWORK
        LOCAL 102          PHONE
                                                                                     NEEDED                                                                                                              NEEDED


                                                                                                                                                                                                         AUTHE
                        INSURANCE                                                                                                                                                                                 FOR 740800 ATLANTA
                                                                                                                                                                                                         NEEDED                                      FOR UNITED HEALTHCARE PPO PLAN (
                          WEB SITE                                 DOCTORS                                                                                                                                         GA ADDR BILL: PRI-
      UNITED HEALTH                 WWW.UNITEDHEALTHCARE                                                                                                                                                DEPENDIN                                  AUTHORIZATION IS NOT NEEDED) --. FOR ANY
                         PRINT OUT                                 REFERRAL            NO           NO           NO           NO             NO             NO               NO     NO        NO                 05683   SEC- 00258 OR
      CARE PPO [ONLY]                    ONLINE.COM                                                                                                                                                       G ON                                  QUESTIONS ABOUT THE PPO PLAN CALL PROVIDER
                        ELIGIBILITY                                 NEEDED                                                                                                                                       ADDR ON THE BACK OF
                                                                                                                                                                                                        MEMBERS                                           RELATIONS AT 800-638-8075
                           FORM                                                                                                                                                                                    CARD IF DIFFERENT
                                                                                                                                                                                                          PLAN


6/30/2010                                                                                                                  PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                           NPI DOSHI # 1720031339//Page 26
                                                                                                             Doshi Diagnostic Imaging Services of New York
                                                                          REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                REF REQ                                                             AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                         CT SCAN &                                                                  NUCLEAR
                         SITE PRINT OUT                                             PET SCAN &                    CT                                                                    MEDICINE &     BREAST
        INSURANCE CO.                                           REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                       CLAIM CENTER                          COMMENTS
                           ELIGIBILITY                                                PETCT                  ANGIOGRAPH                                                                  NUCLEAR       BIOPSY
                              FORM                                                                                Y                                                  VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                            STUDIES     ECHO



                     INSURANCE                                                                                                                                                                        NEED TO    FOR 740800 ATLANTA
    UNITED HEALTH     WEB SITE                                     DOCTORS                                                                                                                           CALL INS &   GA ADDR BILL: PRI-
                                 WWW.UNITEDHEALTHCARE
  CARE EPO-POS-NPP & PRINT OUT                                     REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO      NO         VERIFY IF 05683   SEC- 00258 OR
                                      ONLINE.COM
      BENESIGHT      ELIGIBILITY                                    NEEDED                                                                                                                             AUTH     ADDR ON THE BACK OF
                        FORM                                                                                                                                                                          NEEDED      CARD IF DIFFERENT


     (UNITED HEALTH
       CARE DIRECT)
                                                                                                                                                                                                      AUTHE    FOR 740800 ATLANTA
        UHC CHOICE      INSURANCE
                                                                                                                                                                                                      NEEDED    GA ADDR BILL: PRI-
    UHC CHOICE PLUS       WEB SITE                                 DOCTORS
                                    WWW.UNITEDHEALTHCARE                                                                                                                                             DEPENDIN 05683    SEC- 00258 OR
        UHC SELECT       PRINT OUT                                 REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO      NO
                                         ONLINE.COM                                                                                                                                                    G ON    ADDR ON THE BACK
    UHC SELECT PLUS     ELIGIBILITY                                 NEEDED
                                                                                                                                                                                                     MEMBERS        OF CARD IF
    UHC HMO &HMO +         FORM
                                                                                                                                                                                                       PLAN         DIFFERENT
        (NEED PRE-
      CERTIFICATION)
                                                                                                                                                                                                                                        PCP SHOULD GET THE AUTH BY CALLING 877-769 7447 /
                        INSURANCE                                                                                                                                                                     NEED TO                            MAKE SURE PT HAS THE AUTH, BEFORE PERFORMING
     UNITED HEALTH                                                  DOCTORS
                          WEB SITE                                                                                                                                                                   CALL INS &                          THE TEST, OTHERWISE , EMPIRE PLAN WILL PROCESS
   CARE--EMPIRE PLAN                WWW.UNITEDHEALTHCARE           REFERRAL                      YES, ONLY
                         PRINT OUT                                                     NO                       NO           NO             NO             NO               NO     NO      NO         VERIFY IF   CLAIM CENTER# 04009    THE CLAIM AS OUT OF NETWORK AND THE PATIENT
    (DIV OF UHC PPO &                    ONLINE.COM               NEEDED/ALSO                      MRI'S
                        ELIGIBILITY                                                                                                                                                                    AUTH                              WILL GET HIT WITH $250.00 PENALTY FOR CO-PAYS
          NYSHIP                                                 COLLECT COPAY
                           FORM                                                                                                                                                                       NEEDED                                        CALL 800-942-4640 OR GO TO
                                                                                                                                                                                                                                              WWW.UNITEDHEALTHCAREONLINE.COM

  UNITED HEALTHCARE                                                 DOCTOR                                                                                                                            AUTHE
                         INSURANCE
      DIRECT FOR                                                   REFERRAL                                                                                                                           NEEDED                             WE MUST PUT THE UHC MEDICARE COMPLETE ID #
                           WEB SITE
    PASSPORT PLANS                   WWW.UNITEDHEALTHCARE       NEEDED        (AS                                                                                                                    DEPENDIN     ALL OFFICES CLAIM #   IN THE INSURANCE-ID FIELD, WHICH CONSISTS OF 17
                          PRINT OUT                                                    NO           NO          NO           NO             NO             NO               NO     NO      NO
    Medicare Plan Only /                  ONLINE.COM            OF 1/1/03 INS REF                                                                                                                      G ON              04658            DIGITS. THIS IS A HMO REPLACEMENT PLAN FOR
                         ELIGIBILITY
   SECURE HORIZON                                                IS NO LONGER                                                                                                                        MEMBERS                                              MEDICARE ****
                            FORM
         LOGO)                                                        REQ.)                                                                                                                            PLAN



                                 WWW.AMERICHOICE.COM
                                                                                                                                                                                                                                         FOR DOS PRIOR TO 10/1/06 CONTINUE TO VIEW CLAIMS
                    INSURANCE (As of 10/1/06 date of service
                                                                                                                                                                                                                  AS OF 10/1/06 USE PLAN AND MEMBER ELIG LOG ONTO : UNITED HEALTH CARE
  UNITED HEALTHCARE WEB SITE    log on to Americhoice web for       DOCTOR
                                                                                                                                                                                                                  CODE # 50000 FOR P.O    WEB SITE- ALSO USE PLAN CODE 04658 ///BEGINNING
   MEDICAID*CHP*FHP  PRINT OUT UHC medicaid, Child H.Plus &        REFERRAL            NO           NO          NO           NO             NO             NO               NO     NO      NO           NO
                                                                                                                                                                                                                     BOX 65952 ,SAN        DOS 10/1/06 BILL PLAN CODE # 50000 & USE THE
       PLANS**      ELIGIBILITY      Family H. Plus plan            NEEDED
                                                                                                                                                                                                                   ANTONIO TX 78265      AMERICHOICE WEB SITE TO CHECK ELIG & CLAIM
                       FORM         ELIGIBILITY & CLAIMS
                                          STATUS )                                                                                                                                                                                                            STATUS.


                        INSURANCE
      UNITED HEALTH
                          WEB SITE                                  DOCTOR
        CARE AARP                   WWW.UNITEDHEALTHCARE
                         PRINT OUT                                 REFERRAL                                                  MEDICARE SUPPLEMENT                                                                      CLAIM # 09997
        (MEDICARE                        ONLINE.COM
                        ELIGIBILITY                                 NEEDED
       SUPPLEMENT)
                           FORM



                                                                    DOCTOR
   US DEPARTMENT OF                                                                  NEED TO CALL DEPT OF LABOR AT 850-558-1818 TO CONFIRM WHETHER THE TEST BEING PERFORMED HAS BEEN
                                                                   REFERRAL                                                                                                                                          CLAIM # 02586
       LABOR (WC)                                                                                  AUTHORIZED ..AND ALSO GET CORRECT DIAGNOSIS CODE FROM THEM TO BILL ..
                                                                    NEEDED



                                                                                                                                                                                                                CLAIM CENTER #SEE
                                                                                                                                                                                                                 ADDRESS ON THE
                                                                                     NEED TO                                                                                                          NEED TO INSURANCE CARD (SEE
                         ELIGIILITY                                                                                                                                                                                               FOR INSURANCE CARDS SHOWING MULTIPLAN LOGO ,
                                                                   DOCTORS          CALL INS &                                                                                                       CALL INS &   COMMENTS FOR
                          MUST BE                                                                                                                                                                                                  USE CLAIM CENTER WITH THE (*NYNM). FOR OTHER
   USI ADMINISTRATOR                                               REFERRAL          VERIFY IF      NO          NO           NO             NO             NO               NO     NO      NO         VERIFY IF   CORRECT CLAIM
                        VERIFIED BY                                                                                                                                                                                                   LOGO, EX BEECH STREET LOGO BILL CALIM #
                                                                    NEEDED            AUTH                                                                                                             AUTH          CENTER)
                           PHONE                                                                                                                                                                                                                  WITHOUT NYNM*
                                                                                     NEEDED                                                                                                           NEEDED




                         ELIGIILITY
                                                                    DOCTOR
                          MUST BE                                                                                                                                                                                                        BROOKLYN VA MEDICAL CENTER 800 POLY PLACE
     VETERANS AFFAIR                                               REFERRAL                                           CONTRACTED TO DO PET SCAN ONLY                                                                CLAIM CTR # 05821
                        VERIFIED BY                                                                                                                                                                                                              ,BROOKLYN NY 718-836-6600
                                                                    NEEDED
                           PHONE




                                                                                                                                                                                                                                         VMH 699 92ND STREET,BROOKLYN NY 11228 PHONE
   VICTORY MEMORIAL                                                VMH FORM
                                                                                                                     CONTRACTED TO DO MRI'S/MRA'S S ONLY                                                                  30051         718-567-1260 // FAX REPORT TO THE RADIOLOGY DEPT
       HOSPITAL                                                     NEEDED
                                                                                                                                                                                                                                                          AT 718-567-567-1141




6/30/2010                                                                                                                 PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                   NPI DOSHI # 1720031339//Page 27
                                                                                                             Doshi Diagnostic Imaging Services of New York
                                                                          REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                                REF REQ                                                              AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                         CT SCAN &                                                                   NUCLEAR
                         SITE PRINT OUT                                             PET SCAN &                    CT                                                                     MEDICINE &       BREAST
        INSURANCE CO.                                           REFERRAL REQUIRED                MRA & MRI                   SONO          MAMMO          X-RAYS                                                         CLAIM CENTER                            COMMENTS
                           ELIGIBILITY                                                PETCT                  ANGIOGRAPH                                                                   NUCLEAR         BIOPSY
                              FORM                                                                                Y                                                   VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                             STUDIES     ECHO




   VRN      VISITING
                                                                                                                                                                                                                                            VRN 111 LIVIGSTON ST, BROOKLYN, NY 11201 (718) 923 -
    NURSE REGIONAL                                               VRN REFERRAL                                    CONTRACTED TO DO CHEST X-RAY(2 VIEWS)                                                               CLAIM CENTER # 00051
                                                                                                                                                                                                                                                                   7110
     CARE SYSTEM




                         ELIGIILITY                                                                                                                                                                                                           THIS IS A MEDICAR HMO/ REPLACES MEDICARE*
   VNS-CHOICE SELECT
                          MUST BE                                  DOCTORS                       YES, ALL                                                                                                                                    NASSAU AND SUFFOLK COUNTY DON’T HAVE ANY
    VISITING NURSE                                                                                           YES / ALL                                                                   only nuclear
                        VERIFIED BY                                REFERRAL            YES        MRI's &                     NO             NO             NO               NO     NO                     NO               30060              MEMBERS.. THE OFFICES CAN NOT SEE THESE
     SERVICE OF NY/                                                                                            CT'S                                                                       cardiology
                        PHONE/ 866-                                 NEEDED                        MRAs                                                                                                                                      PATIENTS… FOR AUTHORIZATIONS CALL 1-866-791-
      medicare HMO
                          783-0222                                                                                                                                                                                                                                2215




                                                                                                                                                                                                                                             1) IF DOSHI DIAGNOSTIC IS THE RADIOLOGY SITE FOR
                                                                                                                           NEED AUTHORIZATION FOR ALL TEST WHEN PATIENT'S INSURANCE CARD IS SHOWING
                                                                                                                           DIFFERENT RADIOLOGY SITE.
                                                                                                                                                                                                                                                70000'-79999 SERIES, BILL VYTRA CAP. FOR 9000'S
      VYTRA HEALTH                                                                               YES,AS OF                                                                                                                                   SERIES, BILL VYTRA NONCAP ALSO BILL VYTRA NO-
   (FORMERELY CHOICE                                                                               6/1/01                                                                                                                                                     CAP FOR ALL PET SCAN
     CARE) (CHEK INS   INSURANCE                                                                   AUTH                                                                                                  NEED TO                              2) IF PAT HAS NO RADIOLOGY SITE SELECTED, THEN
    CARD TO SEE IF THE  WEB SITE                                   DOCTORS                        NEEDED                                                                                                CALL INS &       ALL OFFICES                    YOU HAVE TO BILL VYTRA NONCAP.
    MEMBER HAS DOSHI PRINT OUT             WWW.VYTRA.COM           REFERRAL            YES       FOR MRA'S      NO            NO             NO             NO               NO     NO       NO          VERIFY IF      CAP--------05443          3) IF ANY OTHER RADIOLOGY OFFICE NAME IS
    DIAGNOSTIC AS THE ELIGIBILITY                                   NEEDED                       ONLY, SEE                                                                                                AUTH         NON CAP---00521      MENTIONED ON THE CARD, THEN WE CAN'T SEE THAT
       DESIGNATED         FORM                                                                   COMMENT                                                                                                 NEEDED                                   PATIENT WITHOUT AUTH, GET AUTH FOR ALL
    RADIOLOGY OFFICE                                                                               S FOR                                                                                                                                            PROCEDURES AND BILL VYTRA NON CAP).
     (SEE COMMENTS)                                                                                MRI'S                                                                                                                                       4) AS OF 6//1/01 AUTH IS NEEDED FOR ALL MRA'S .
                                                                                                                                                                                                                                                 AUTH IS NEEDED FOR MRIS ONLY IF THE PAT IS
                                                                                                                                                                                                                                            HAVING ANAESTHESIA . FOR AUTHORIZATION CALL -
                                                                                                                                                                                                                                                                   888-288-9872
                                                                                              YES,AS OF
                                                                                                6/1/01
                                                                                                                                                                                                                                            NEED AUTH FOR ALL MRA'S. AUTH ALSO NEEDED FOR
                        INSURANCE                                                               AUTH
                                                                                                                                                                                                                                            MRI'S ONLY IF THE PAT IS HAVING ANAESTHESIA. THIS
          VYTRA           WEB SITE                                  DOCTOR            CALL     NEEDED
                                                                                                                                                                                                          CALL                               PLAN PROVIDES IN-NETWORK BENEFITS , PAT DON'T
     EAST END HEALTH     PRINT OUT         WWW.VYTRA.COM           REFERRAL         HICKSVILL FOR MRA'S         NO            NO             NO             NO               NO     NO       NO                       ALL OFFICES# 00521
                                                                                                                                                                                                        HICKSVILE                           SELECT A PCP SO WE HAVE TO BILL VYTRA-NON-CAP.
      PLAN (EEHP)       ELIGIBILITY                                 NEEDED              E     ONLY, SEE
                                                                                                                                                                                                                                               RADIOLOGY CO-PAY AS INDICATED ON ID CARD.
                           FORM                                                               COMMENT
                                                                                                                                                                                                                                                    FOR AUTH CALL PHONE # 888-288-9872
                                                                                                S FOR
                                                                                                MRI'S


                      ELIGIILITY
     WATCHTOWER                                                     DOCTOR
                       MUST BE
  ***SEE HEALTH CARE                                               REFERRAL                                               SEE HEALTH CARE SUPPORT FOR GUIDELINES
                     VERIFIED BY
       SUPPORT                                                      NEEDED
                        PHONE


                                                                                                                                                                                            AUTH
                    INSURANCE                                                                                                                                                                       NEED TO
                                               FOR ELIG                                                                                                                                    NEEDED
   WELLCHOICE HMO &   WEB SITE                                      DOCTOR                                                                                                                         CALL INS &
                                           www.empireblue.com                                                                                                                             ONLY FOR
   ACCESS-HMO EHP    PRINT OUT                                     REFERRAL            YES,        YES          YES           NO             NO             NO               NO     NO              VERIFY IF        ALL OFFICES # 08900                WELLCHOICE 1-888- 476-7245
                                              FOR AUTH                                                                                                                                    (NUCLEAR
        PREFIX      ELIGIBILITY                                     NEEDED                                                                                                                           AUTH
                                           WWW.RADMD.COM                                                                                                                                 CARDIOLOG
                       FORM                                                                                                                                                                         NEEDED
                                                                                                                                                                                             Y)

                                                                                                                                                                                            AUTH
                                                                                                                 AUTH                                                                      NEEDED                                               FOR ELEGIBILTY CALL 800-288 5441 WELCARE
        WELLCARE        INSURANCE                                                     AUTH     AUTH     AUTH
                                                                                                               NEEDED                                                                     ONLY FOR                                          DIRECT/////   FOR CLAIMS STATUS CALL 800-278-5155
     MEDICARE PLAN,       WEB SITE                                  DOCTOR           NEEDED   NEEDED   NEEDED
                                                                                                                 ONLY                                                                    MEDICARE                                           BILL CLAIM # 1612 PRIOR TO 5/15/01    AS OF 3/14/05
      CHILD H.PLUS,      PRINT OUT        WWW.WELLCARE.COM         REFERRAL         ONLY FOR ONLY FOR ONLY FOR                               NO             NO               NO     NO                     NO        CLAIM CENTER # 02289
                                                                                                                  FOR                                                                       PLAN                                                             AUTH IS NEEDED
     HEALTHY CHOICE     ELIGIBILITY                                 NEEDED          MEDICARE MEDICARE MEDICARE
                                                                                                               MEDICAR                                                                    (NUCLEAR                                          PATIENT CAN HAVE ONE SCREENING MAMMO EVERY
       (MEDICAID)          FORM                                                       PLAN     PLAN     PLAN
                                                                                                                E PLAN                                                                   CARDIOLOG                                                              12 MONTHS.
                                                                                                                                                                                             Y)


       WORKSITE                                                                      NEED TO
    TREATMENT DR.                                                   DOCTOR          CALL INS &                                                                                                                                                 FILMS & REPORT HAS TO BE SENT TO WORKSITE
       ANDREAS P.                                                  REFERRAL          VERIFY IF                             CONTRACTED TO DO ONLY CHEST X-RAY                                                          CLAIM CTR # 09329          TREATMENT , ATT: DR. JOAQUIN NEGRETTE
   NIARCHOS 501 FIFTH                                               NEEDED            AUTH                                                                                                                                                        PATS WILL BE SEEING IN TRIBECA OFFICE.
     AVE,NY,NY 10017                                                                 NEEDED




                                                                                                                                                                                                                     #00731 WORKMEN'S IS
    WORKMEN'S CIRCLE                                               SELF PAY
                                                                                    DOSHI HAS A CONTRACT WITH WORKMEN'S CIRCLE TO GIVE DISCOUNT TO THEIR SELF PAY PATIENTS                                            NOT A INSURANCE
   (DISCOUNT FOR SELF                                            PATIENTS WILL
                                                                                    ONLY / FOR PRICES SEE /M13 OPTION # 1(PROCEDURES) . FRONT DESK HAS TO COLLECT PAYMENT.                                           COMPANY/PATIENTS
      PAY PATIENTS)                                              GET DISCOUNT
                                                                                                                                                                                                                         ARE SELF PAY


6/30/2010                                                                                                                  PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                                       NPI DOSHI # 1720031339//Page 28
                                                                                                         Doshi Diagnostic Imaging Services of New York
                                                                      REQUIREMENTS TO BILL INSURANCE COMPANIES 2007
                                                            REF REQ                                                             AUTHORIZATION REQUIRED

                        INSURANCE WEB                                                                     CT SCAN &                                                                  NUCLEAR
                         SITE PRINT OUT                                         PET SCAN &                    CT                                                                    MEDICINE &   BREAST
        INSURANCE CO.                                       REFERRAL REQUIRED                MRA & MRI                  SONO          MAMMO          X-RAYS                                                  CLAIM CENTER                          COMMENTS
                           ELIGIBILITY                                            PETCT                  ANGIOGRAPH                                                                  NUCLEAR     BIOPSY
                              FORM                                                                            Y                                                  VASCULAR           CARDIOLOGY
                                          WEBSITE ADDRESS                                                                                                        STUDIES     ECHO



                                                                                                         YES, IF IT                                                                                                              IF THE TEST OR TESTS EXCEED OVER $500.00(CHECK
                                                                                                          IS OVER                                                                                                                 WORKER'S COM FEE IN /M13, OPTION #4) THEN WE
                                                                                                            $ 500                                                                                                                   NEED WRITTEN AUTH. FROM THE WC CARRIER,(
      WORKERS COMP/                                                              NEED TO
                         ELIGIILITY                                                                       AUTH IS                                                                                                                 APPOITMENT LETTERS IS NOT ACCEPTABLE) THIS
     NEED AUTH OVER                                            DOCTORS          CALL INS &
                          MUST BE                                                                        NEEDED (                                                                                                               ALSO APPLY TO MULITIPLE TESTS DONE ON THE SAME
    $500, APPOITMENTS                                          REFERRAL          VERIFY IF     YES                       NO             NO             NO               NO     NO      NO                 ALL OFFICES # 01410
                        VERIFIED BY                                                                      APPOITME                                                                                                                                       DAY.
     LETTERS ARE NOT                                            NEEDED            AUTH
                           PHONE                                                                             NT                                                                                                                          GET PAT' S EMPLOYER INFORMATION
           AUTH#                                                                 NEEDED
                                                                                                         LETTER IS                                                                                                                (PHONE,ADDRESS AND CONTACT PERSON). IF THE
                                                                                                          NOT THE                                                                                                                    DATE OF ACCIDENT IS OLD/ PT SHOULD HAVE
                                                                                                           AUTH.)                                                                                                                      INSURANCE INF & CLAIM# AND WCB# .




6/30/2010                                                                                                             PREPARED BY ROXANNE GONZALEZ (ROXYGONZ@AOL.COM)                                                                              NPI DOSHI # 1720031339//Page 29

								
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