Mount Sinai Radiology Insurance Information
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1 Mount Sinai Radiology Insurance Information Insurance Carrier Plan Eligibility Precertification Precert. Phone Number 1199 Care to Care 1199 Home Care & Multiplan (646) Care to Care (888) CareCore Aetna HMO/PPO,MC POS (888) Provider ID# Affordable Multiple Plan, First Health PPO & Workers Compensation AIM (866) NIA Amerigroup Medicaid HMO (800) Amidacare Medicaid HMO (800) No Authorization except for (800) or NIA # (888) Arch Care Beech Street Authorization letter is CT/CTA, MRI/MRA, NM, /US/XRAY Call insurance plan (866) Shield CT/CTA,,MRI/MR, NM (Heart only), All Plans require referral form for US /CT biopsy exams Certain plans require
2 Auth Shield EMPIRE CT/CTA, MRI/MRA, NM (Heart only), Referral form is for US / CT biopsy exams AIM (877) opt.1 Approve under NPI# Shield FEDERAL NO AUTH. REQUIRED Shield of New Jersey HORIZON CT/CTA, MRI/MRA, NM (Heart only), Referral form is for US / CT biopsy exams CareCore ProviderID# CCM- Comprehensive Care Management CCM (718) or (212) Referral from CCM needed for all procedures (646) Commercial Ins. Call Insurance Plan Auth for certain services. CT/CTA, MRI,MRA, PET SCAN, US/XRAY Authorization is CT/CTA, MRI/MRA, MedSolutions Cigna HMO, POS, Open access & PPO (800) Film consults -No authorization - Interventional Radiology needs authorization (888) from 8am-9pm or at: cigna.medsolutionsonl ine.com Fidelis Medicaid (888) Various requirements for exams Script is.
3 GHI (EMBLEM HEALTH) HMO, PPO, Comprehensive Benefits Plan (212) Provider ID# Great West Out-of-Network (800) Guardian (888) Health Plus Medicaid HMO (800) Authorization for: MRI/MRA, US-pregnant pelvis Referral for: All other procedures (800) opt. 3,7 Approve under NPI # Health first 65+, Medicaid HMO (888) Prescriptions needed for X-Ray/US Provider ID#163125A12 HIP EMBLEM HEALTH Medicaid HMO (800) HIP REFERRAL for US/ X- Rays If not handled by obtain referral from HIP / PCP Provider ID# PRIS# 39794P (Simpson, W. MD) Healthcare Partners HIP Healthcare Partners # ( ) RM-REDS (Rabinowitz, J. MD) International Ins. Call Insurance Plan Auth for certain services CT/CRA, MRI/MRA, PET
4 SCAN, US/XRAY Magna Care Call insurance (800) Call insurance Medicare PART B (877) Medicaid New York Metro Plus Medicaid HMO (212) CT/CTA, MRI/MRA, NM (Heart only), (888) Metro Plus (800) Multiplan Call insurance plan Neighborhood Health & Medicaid HMO (800) and ULTRASOUND (800) NPI # No Fault Case must be open Letter of Medical Necessity is from the Primary Care Provider Oxford All plans accepted (800) Provider ID# A PHCS All plans accepted Call insurance plan Pomco PPO Call insurance plan Select Health New York Medicaid HMO (212) (212)
5 Presbyterian United Healthcare Empire Plan (888) opt. 3 (888) opt. 3 United Healthcare Choice Plus (Mount Sinai Employees) (877) United Healthcare New Jersey (877) Provider ID# AARP United Healthcare Secure Horizons (877) , opt. 2 (866) Evercare United Healthcare UMR (866) Auth for certain plans CT/CTA, MRI/MRA, PET SCAN (866) VNS Choice (866) Check for Authorization (866) Worker s Compensation MRI-All need Authorization EXCEPT EXAMS for BACK, NECK, SHOULDER OR KNEE CT-Authorization is if patient is having more than one CT exam, All NM and World Trade Center Authorization form is for all exams
6
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Mount Sinai Brooklyn. Beth Israel/ Petrie. Y Y Beacon Y Y Y Beacon. Y Y Beacon Y Y Y Beacon. Y Y Beacon Y Y Y Beacon. Y Y Beacon Y Y Y Beacon
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