UH - Managed Care Office

	Office of Managed Care Operations

FIRST OPTION HEALTH PLAN

	Quick Reference Guide
	Telephone Guide
	Claims Address
	Health Net (This link is provided for the convenience of our website visitors. UMDNJ University Hospital takes no responsibility for the information or proprietary of the web sites listed above.)

FIRST OPTION HEALTH PLAN QUICK REFERENCE GUIDE

Facility/Provider # Inpatient # IL5186 Outpatient # IL5187

ELECTIVE	REQUIREMENTS
INPATIENT ADMISSION	Authorization Required 5 Days Prior to Admission by Admitting Physician or Hospital
SAME DAY SURGERY	Authorization Required by Admitting Physician or Hospital
OUT PATIENT PROCEDURE	Authorization Required by Admitting Physician or Hospital

NOTE: Admitting Physician must call to obtain authorization @ 1-800-438-7886
(pre-certification). Hospital Admitting Department must call Health Net prior to admission or surgery to make admission or Surgery has been authorized.

NOTE: If HEALTHNET Is Secondary Carrier and HEALTHNET is not the Primary Insurance No Authorization or Pre-certification Is Required.

EMERGENCY/DIRECT

EMERGENCY ROOM VISIT	PCP or Member must notify Health Net @ 1-800-438-7886 within 24-Hrs or next business day. Hospital must call to obtain authorization # within 24 hrs-or next business day.
EMERGENCY ADMISSION	24-hr or next day notification required by PCP or Hospital to obtain authorization #.
DIRECT ADMISSION	Authorization Required by PCP or Hospital (24-hr or next business day notification required)
MENTAL HEALTH/ADMISSION SUBSTANCE ABUSE	See Note below
NON EMERGENCY MENTAL HEALTH & SUBSTANCE ABUSE	See Note below

NOTE: For all Mental Health & Substance Abuse Admission, please contact Managed Health Network (MHN) @ 1-800-728-9899 prior to services.

NOTE: If HEALTHNET Is Secondary Carrier and HEALTHNET is not the Primary Insurance No Authorization or Pre-certification Is Required

HEALTH NET QUICK REFERENCE GUIDE

Pre-Authorization Requirements

PRE AUTHORIZATION REQUIRED –OUTPATIENT

Specialist Visit

Non – Emergent Ambulance Transportation

Rehab

Therapy PT/RT/OT/Speech

Oral Surgery

Radiation Therapy (Referral also Required)

Laboratory Services

Audio logy Svcs.

Radiology Routine

Nuclear Medicine

Ultrasound (Non OB related)

CT Scan

MRA

Pet Scan

Nuclear Medicine

Select Ultrasound Procedures.

NOTE: Behavioral Health & Substance Abuse Must contact Managed Health Network prior to services.

NOTE: If HEALTHNET Is Secondary Carrier and HEALTHNET is not the Primary Insurance No Authorization or Pre- certification is Required.

FIRST OPTION HEALTH PLAN TELEPHONE GUIDE

HEALTH NET Senior Hospital / Ancillary Field Rep. Network Management Darryl Holley	732-353-7496 Fax # 732-353-7510
HEALTH NET Member Service Department	1-800-562-4347
HEALTH NET Provider Service Department	1-800-963-6286
HEALTH NET Pre-certification Department	1-800-438-7886
CARECORE – Radiology Services Care Core Provider Services (NJ Providers) 8:30am-5:00 pm Care Core Prior Authorization (NJ Provider) 7:00am-6:00 pm	1-866-469-8989 1-866-469-8989 Fax Line: 845-297-3940
Home Care –Health Net	1-8000-438-7886
Mental Health – Managed Health Network	1-800-728-9888
Chiropractic Services (Landmark)	1-800-638-4557
ALL DME – Durable Medical Equipment	1-800-294-2275
Laboratory Services: QUEST Diagnostics	1-800-631-1390

FIRST OPTION CLAIMS ADDRESS

ACS/ Health Net
P.O. Box 14700
Lexington , KY 40512

COB CLAIMS
ACS/ Health Net
P. O. Box 14700
Lexington , KY 40512

CLAIM APPEALS
Care Core national
169 Myers Corners Road
Wappingers Falls , New York 12590
Attention: Claims Appeals

MENTAL HEALTH CLAIMS
Managed Health Network
5100 West Gold Leaf Circle Suite 300
Los Angeles , Ca 90056

SKILLED NURSING & SUB-ACUTE SERVICE CLAIMS
Coordinated Care Solution, Inc.
12301 Northwest 39 th Street
Coral Springs , FL 33065

CHIROPRATIC CLAIMS
Landmark Health Care
1750 Howe Avenue . Suite 300
Sacramento , CA 95825

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