Office of Managed Care Operations

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.

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Last Reviewed: December 2011
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