Insurance Precertification and Referrals
Insurances That Require Pre-Certification & Insurance Referrals
1199Effective 10/01/07, 1199 members will require prior approval for MRI/MRA and CT scans from Medfocus. (888) 910-1199 |
Health PlusAll members require pre-certification for MRI/MRA, PET, and 3rd OB Ultrasound. (800) 450-8753 |
32BJ Empire BC/BSAll members require pre-certification for MRI/MRA. (866) 316-3394 |
HIPPre-certification required for MRI/MRA and CT scans via CareCore National (866) 417-2345 Some plans may require pre-certification via HIP Management (888) 447-2884. Referrals are required for all HMO policies as well as some POS/PPP Policies. HIP Access I and II Plans DO NOT require referrals. |
AetnaEffective 05/01/07, pre-certification requirements vary per plan. You must call Aetna (888) 632-3862 option 3 for guidelines. New York based plans usually require pre-certification via CareCore National. |
HIP HeritageAll members require pre-certification for MRI/MRA and CT Scans. (800) 746-2200 |
AffinityAll members require referrals for CT and MRI. (866) 247-5678 |
MAGNACAREPre-certification requirements vary per plan. Please call number on card to verify pre-certification guidelines.(800) 235-7267 |
AMERICHOICEEffective 03/01/08, prior approval is required for MRI/MRA. (866) 604-3267 |
MedicaidPlease call Medicaid to ensure patient’s coverage is not through a Managed Care plan. |
Anthem BC/BSAll members require pre-certification for MRI/MRA via NIA (888) 864-7237 |
MedicarePre-certification is required for HMO Plans. Please verify policy through Medicare. |
Atlantis HealthAll members require pre-certification for MRI/MRA, CT and DEXA scans. (800) 270-9072 |
MultiplanPre-certification requirements vary per plan. Please call number on card to verify pre-certification guidelines. (800) 546-3887 |
Blue Cross Blue ShieldPre-certification requirements vary per plan. BCBS require pre-certifcation for MRI/MRA and CT scans for all Empire HMO products and EPO plans via NIA (888) 899-7803. Empire HMO products include HMO, Direct HMO, Direct POS, Direct Pay HMO, Child Health Plus, Healthy NY and MediBlue (formerly Senior Plan). Out of state plans must call number on the card for guidelines. |
OxfordPre-certification required for MRI/MRA and CT scans via CareCore National (866) 417-2345 |
CIGNAPre-certification requirements vary per plan. Cigna HMO and Premier Plus need pre-certification for MRI/MRA and CT Scans via American Imaging Management (800) 252-2021. |
PerfomaxPre-certification required for MRI/MRA and CT scans. (800) 337-0506 |
ElderplanNo prior approval required for any diagnostic testing. |
PHCSPre-certification requirements vary per plan. (800) 922-4362 |
Empire Government Plan (NYSHIP)Effective 07/01/08, pre-certification is required for MRI/MRA, CT/CTA and Nuclear Medicine exams. (888) 333-9067 |
PHS/HealthnetAdvantage Platinum plan (PPO, HMO, POS) members require pre-certifcation for MRI/MRA and CT Scans via CareCore National (866) 898-6287. For our of state plans, pre-certification is via NIA (800) 642-6551 |
GEHAAll members require pre-certification for MRI/MRA and CT Scans. (866) 879-8317 |
United HealthcareNew York based plans do not require pre-certification. New Jersey based plans (either patient or employer resides in NJ) require pre-certification via CareCore National. (800) 818-8307 |
GHIAll members require pre-certification for MRI/MRA and CT Scans via CareCore National. (800) 835-7064 |
WellcareFor Medicare plan, pre-certification is required for MRI/MRA and CT Scans (fax request which can only be approved by Medical Director). For Medicaid plans, pre-certification is required for MRA only. Referrals required for MRI and CT scans. |
HealthFirstAll members require pre-certification for MRI/MRA and CT Scans via CareCore National. (800) 835-7064 |
* Please be aware that our facilities accept insurances other than those listed. If you do not see your insurance or have any questions regarding pre-certification and/or referrals, please contact us at (516) 354-4200 or info@lirad.com.
