INSMATRIXNEWYORK.xls
Document Sample
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
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