Managed Care
Organization |
Provider Relations Telephone Number |
Pre-certification Telephone Number |
AETNA
(Merged w/NYLCARE) |
Sal Di Salvio
Hospital Provider Representative
973-244-3513
Denise A. Ferguson
1-800-852-0629 Ext.43075
Viola A. Smith
Implementation Specialists Provider E Services for NJ
888-404-8962
Fax: 860-262-7715
|
HMO –based benefits plans
1-800-624-0756
Indemnity & PPO based benefits plans
1-888-632-3862
Clinical Appeal/and or request appeal status to fax number:
|
Aetna Patient Management Department
HMO-1-800-624-0756
Open Choice PPO & Traditional
1-888-632-3862
Managed Choice POS & Elect Choice EPO 1-800-223-6857.
(8 a.m. – 5 p.m.)
Magellan Behavioral Health
1-800-424-4506
Aetna Pharmacy Management for
Pre-certification of Oral Medications Only
1-800-414-2386
Aetna Specialty Pharmacy for Information on Injection
Medications
1-866-782-2779
Moms –to-babies Maternity Management Program, Including
genetic testing, antenatal testing, prenatal counseling
1-800-272-3531
BRCA genetic testing
1-877-794-8720
Infertility Program
1-800-575-5999
High End Radiology Pre-certification for Elective Outpatient
Care Core National
1-845-298-8155
Fax- 1-845-918-8924
Aetna National Medical Excellence Program for all major organ transplant
evaluations and transplants including but not limited to kidney, liver,
heart, lung and pancreas, and bone marrow replacement or stem cell transfer
after high –dose chemotherapy.
1-877-212-8811
(Metro NY/Northern NJ) For HMO –based plan members only: Out patient Physical
and Occupational Therapy Pre-Certification through Orthonet
1-800-771-3205
Sleep Care Centers
1-800-753-3779 |
AMERIGROUP |
Hospital Provider Representative
Lori Jackson
732-452-6032
Fax# 732-906-8327
Hospital Physician Provider Representative
Shanise Williams
732-452-6000 Ext. 66165
Providers Services
1-800-454-3730
Electronic Data Interchange (EDI)
1-800-590-5745
|
Care Management Services
1-800-454-3730
Fax : 1-800-964-3627
24/7/365 Nurse Helpline
1-800-600-4441
Radiology Management
National Imaging Associates
877-807-2363
Behavioral Health Information
Fax#:
1-800-505-1193
Vision Care (Routine)
Members
Contact
Block Vision
1-800-428-8789
Pharmacy
Care Mark Customer Service
800-241-2784
FEB Members
800-262-7890 |
*AMERICHOICE Inc. |
Provider Relations & Member Eligibility
1-888-362-3368
Jennifer Hong
Provider Representative
732-623-1953
Personal Care Model
1-888-362-3368
Dental Services Unit
1-888-362-3368
Credentialing Inquiries
1-888-362-3368
Member Help Lines
Medicaid, NJ Family Care
1-800-941-4647
AMERICHOICE Personal Care Plus (Medicare)
1-800-514-4911
|
Medical /Surgical
1-888-362-3368
Fax# 973-565-5255
Maternity/Newborn
1-866-820-6667
Fax : 1-973-565-5132
Behavioral Health
1-888-362-3368 #4
Fax : 1-212-898-8368
Pharmacy Prior Authorizations
1-800-711-4555
(Monday –Friday 9am-9:00pm)
Out of Plan Referral
or Referral to Non Participating
Providers
1-888-362-3368 Option # 2
|
* AmeriHealth, Inc. (Medicaid product brought by
Mercy) |
Kim Miller
Hospital
Service Coordinator
856-778-6545
email:kim.miller@amerihealth.com
Provider Services
HMO Policies/Procedures/Eligibility/Claims
800-821-9412
Provider Services
PPO
Policies/Procedures/Claims
800-595-3627
Customer Service/Member Service
AmeriHealth HMO
800-877-9829
AmeriHealth PPO
800-422-2457
AmeriHealth 65
800-645-3965
The Provider Supply Line
800-858-4728
Pharmacy Appeals
888-494-8213
NaviNet Portal Registration and Questions
856-638-2701
NaviMedix
888-482-8057 |
Case Management & Coordination (formerly Patient Care
Management)
HMO/PPO (Medicare & Commercial
800-313-8628 or for NJ Members
836-778-6374
Pre-certification
800-227-3116
American Imaging Management (AIM)
(Call for MRI/MRA, PET and Nuclear Cardiology for AH NJ Members
800-859-5288
Baby Foot Steps
Prenatal Case Management Nurse on Call 24 hours a day
800-598-BABY
Magellan Behavioral Health Members Services/
Pre-certification
800-809-9954
Prescription Drug Pre-Authorization
888-678-7012
Fax # 888-671-5285
|
AtlantiCare
Health Plan
|
1-800-272-5995
|
1-800-272-5995
|
* Empire
Blue Cross/
Well Choice |
Empire Provider Service
1-800-552-6630
1-800992-2583
Monday-Friday 8:30am – 5:00 pm
Empire Blue Cross
Fast Check
888-476-7245
FAX # 518-367-3101
New Jersey Provider Relations Representative
Maria Pawlik
718-312-4018
Carol Hartnett
1-888-476-8069
Ext 6122
Well Choice Provider Relations
1-888-438-8624
Empire Claim Submission
Electronic Commerce Services
1-866-889-7322 |
Medical Management
Case Management
Department
Empire HMO
Case Management Program
800-441-2411
Empire PPO
Case Management Program
800-982-8089
Empire Traditional Indemnity
Case Management Program
800-548-0120
Empire Maternity Care
(For PCP’s and OB/GYN’s)
Empire Medical Management
1-800-845-4742
Empire Discharge Summary (LAD Report)
1-800-426-7844 Nurse Call Center after 5pm nights, weekends, and holidays
1-800-426-7844 Option 9
Fax # 1-518-367-5362
Behavioral Health/Substance Abuse
Magellan Health Services
800-626-3643 Prompt # 6
(24 hours a day. 7 days a week)
Empire Manage Vision Care
888-393-2583
Empire Pharmacy Management
Caremark
800-839-8442
|
Health Net
(Formerly Physician Health Services (PHS)) |
Health Net General Provider Inquires
800-438-7886
Hospital Senior Provider Representative
Michael Cook
732-353-7459
Physician Representative
Stephanie Vonelli
732-353-7328
Eligibility/Co payment Verification
800-622-7708
Paper Claim Questions:
Provider Services
8000-438-7886
Electronic Claim Submission
Emdeon
((Web MD)
877-469-3263
Carrier Code #06108
Med Avant (Proxy med)
800-792-5256
MD On-Line
888-499-5465
Electronic Claim Submission Questions
866-334-4638
|
Prior Authorization
800-438-7886
Fax (888) 747-5747
Appeals & Grievances
Telephone 888-747-8494
Fax Clinical
(203) 225-4159
Fax Administrative
(203) 225-4151
Medicare fax(203)225-4022
Laboratory Services
Quest Diagnostics
888-631-1390
Facility Locator
800-225-7483
Specimen Pick – Up
800-223-0570
Radiology Service
Care Core National
866-469-8989 Option 2
Homecare Care Guide
: 888-747-6747
Behavioral Health & Substance Abuse:
MHN
800-728-9899
Chiropractic /Acupuncture
Landmark
800-638-4557
Durable Medical Equipment (DME) Service
Apria Healthcare
800-294-2275
Physical Therapy Services
Landmark Healthcare
877-531-9139
Skilled/Sub-acute Services
Care Guide
888-747-6747
|
Health Plans of
America (Formerly Mission Health Plans, Inc.) Separated into BCBS
and UHP |
Cathedral members
1-800-355-2583 (BCBS)
Non-Cathedral 973-623-8700 (UHP)
|
1-888-321-3216 |
* Horizon
Blue Cross &Blue Shield (PPO/POS/HMO/Indemnity) |
Horizon Blue Cross Provider Relations Department
1-888-666-2535
Hilary Badner
Senior
Hospital Relation Representative
973-466-5498
Denise Sparrow
Contract
Reimbursement Analyst
973-466-5865
Eric Lansey
Hospital Account Executive Network Hospital Relations
973-466-8121
General Motors Prefix
(DEH, DTP, DMM, NGM)1-800-452-9336
R- Followed by 8-digits
1-800-624-5078 |
1-800-664-BLUE (2583)or for HMO/POS
Federal/FEP 1-800-664-12583
Indemnity/FMA & FMR Prefix
1-800-932-3203 & 3204
Local 835 & Local 108
973-921-1661
Mental Health or Substance Abuse(Magellan Behavioral)
1-800-626-2212 |
Horizon NJ Health
(Formerly Horizon Mercy) |
Horizon NJ Health Provider Relations
1-800-682-9090
Provider Service Consultant
Cynthia Hardy
609-538-0700
New Jersey State Health Benefits Coordinator
1-800-701-0710
Health & Wellness Center
800-682-9094
Member Enrollment
800-637-2997
Member Services
877-765-4325
Inpatient Rehabilitation
1-800-682-9094 Ext. 5104
Horizon NJ Health Medical Director
800-682-9094 Ext. 5181
Physician & Health Care Center Hotline
1-800-682-9091
Family Planning
1-800-833-3344
Mom’s GEMS Prenatal Program
1-800-682-9094
Newborn Enrollment Contact
County Board of Social Services and Health Benefits Coordinator
1-800-701-0710
CHAMPS
Preventive Health and Wellness Program for Children & Adolescents
1-800-682-9094
Member Non- Compliance
1-877-765-4325
24 hrs, 7 days a week
|
Horizon NJ Health
Utilization Management Department
1-800-682-9094
Pre-Certification Forms can be Faxed
609-538-0829
Care Coordination Unit
1-800-682-9094
(Prompt # 2)
Fax# 609-538-0932
Radiology Services
NIA (UM)
1-800-642-7299
Pharmacy Department
800-682-9094 Ext 5452
Horizon NJ Health Care Dental Services
1-800-632-3629
Magellan Behavioral Health
1-877-695-5612
Lab Corp Customer Service
1-800-631-5250
Social Services Department
1-800682-9094
Ext 5192
Verbal Appeals Hotline
800-682-9094 Ext. 5606
|
Oxford
Health Plans
|
1-800-444-6222 |
1-800-444-6222 |
Coventry
Healthcare (formerly Principal Health Care of Delaware, Inc.) |
1-800-833-7423 |
1-800-833-7423 |
QUALCARE |
Hospital Provider Representative
Eileen McCoy
732-562-2827
QUALCARE Provider Relations
Department
1-800-992-6613
QUALCARE Worker’s Compensation Network
800-425-3222
GHI Provider Relations
800-471-2033
|
Utilization Management
QUALCARE
PPO
800-992-6613
QUALCARE
HMO/POS
800-254-0130
Nurse Advice Line
1-800-622-9529 |
United
Healthcare
of New Jersey |
Provider Services Department
1-800-638-8075
&
1-877-842-3210 |
United Healthcare Care Coordinator Department
1-800-638-7388
&
800-638-3323 |
*
University Health Plans |
Provider Services Department
1-800-780-2438 option 4
Hospital Provider Representative
Bridgette Dortilus
Centene Edi Department
1-800-225-2573 or
email @ EDI@centene.com
Member Services
800-564-7897
TDD
1-800-414-7592
Nurse Wise
1-800-564-6847 option #7
Children’s Special Health Care Services
(CSHCS) Program
First Steps: 800-564-6847
CSHCS: 800-564-6847
|
Medical Management/Case Management Prior Authorization
1-800-429-4585
Fax# 1-973-623-5548
Pharmacy Scip Solutions
Prior Authorizations/Claims Issues
1-800-555-8513
Fax # 800-583-6010
Emergency Transportation
High Mode Transportation
1-800-429-4585
Low Mode Transportation
1-800-564-6847
Vision Davis Vision
1-800-998-5431
Dental Doral Dental Services
1-800-341-8478 |
WELLCHOICE |
Carol Hartnett
1-888-476-8069
Ext 6122
Empire Provider Service Line 1-888-476-7245 |
HMO Medical Management
1-800-441-2411
PPO Medical Management
1-800-982-8089
Indemnity Medical Management
1-800-548-0120
BEHAVIORAL Health Care Management Program
HMO 1-800-635-6626
PPO 1-800-626-3643
Indemnity 1-800435-8184 |
