bn

Office of Managed Care Operations


gh

Customer Service

HMO REQUIREMENTS FOR OUT PATIENT LAB PROCEDURES

Revised: December 2011


MANAGED CARE ORGANIZATION


LAB SERVICES CAN BE DONE AT UMDNJ

 


AUTHORIZED LAB FACILITY

 


PRE ADMISSION TESTING CAN BE DONE


AETNA


NO





QUEST DIAGNOSTICS

Script Required


YES

 


AMERIGROUP Community Care



NO





LABCORP

Script Required   


YES


AMERIHEALTH
Mercy Health Plan  



NO



QUEST DIAGNOSTICS

Script Required



YES

United Healthcare Community Plan
(formerly) AMERICHOICE


NO




LABCORP

Script Required

YES

EMPIRE BLUE CROSS
 & BLUE SHIELD

NO




QUEST DIAGNOSTICS

Script Required

 

Yes


HORIZON BLUE CROSS & BLUE SHIELD


TO BE DETERMINED Must Contact Insurance Carrier for Location
888-666-2535

FOR BLUE CARD CONTACT
800-676-2583



TO BE DETERMINED Must Contact Insurance Carrier for Location


LABCORP

Script Required


YES


HORIZON NJ
HEALTH


NO





LABCORP

Script Required

YES

 


QUALCARE


NO


Lab Corp

OR
QUEST DIAGNOSTICS
Script Required




YES

WELLCHOICE

NO

QUEST DIAGNOSTICS

Script Required
 

YES

 

Note: Great West Health Care Contract Terminated with University Hospital June 29, 2008


Note: AMERICHOICE was Purchased by United HealthCare & Name
 was changed to United Community Care
 

Note: AMERIHEALTH Inc. Insurance Contracted Terminated
 with University Hospital November 9, 2010

 


Note: HEALTHNET Insurance Company Medicaid Purchased
 By United HealthCare Insurance


Note: UNIVERSITY Health Plan Insurance Company
 No Longer Provides NJ Family Care Services
 In New Jersey as of
 December 31, 2010 University Health Plan
 Medicaid Products Purchased
 By AMERIGROUP Community Care




University Hospital Does Not Have a Contract with the Following Insurance Companies

First Health NJ – Must Utilize Quest Diagnostic Lab for Out Patient Laboratory Services.
  If Member is Utilizing Out of Network Facility Must Contact Medical Management
 for Authorization or to see if able
 to Utilizing Out of Network Facility for Laboratory Services.

 


Oxford Health Plan Of New Jersey Must Utilize Lab Corp.
 If Member is Utilizing Out of Network Facility,
 Must Contact Medical Management for Authorization
 or to Verify if able to Utilize Out of Network Facility for Laboratory Services.     


United HealthCare Insurance Must Utilize Lab Corp for Out Patient Laboratory Services.
  If Member is utilizing Out of Network Facility,
 Must Contact Medical Management for Authorization
 or to Verify if patient is able to Utilize Out of Network Facility for Laboratory Services. 

 

bullet Flowchart    
bullet Pre Admission Test Requirements @ University Hospital – February 2011 New    
       
bullet Who should use this website bullet Managed Care Glossary of Terms
bullet Disclaimer bullet Get More Information
       

Click Here for Information
(all information subject to change without notice)

    

 

mco web home

sew

University Hospital | UMDNJ | NJMS | NJ Med PC

sew

Last Reviewed: December 2011
All contents copyright 1997-8 UMDNJ. All rights reserved
All information within this site subject to change without notice.

University Hospital
150 Bergen Street
Newark, NJ 07103 USA
(973) 972 - 4300