UH - Managed Care Office

MANAGED CARE ORGANIZATION	MAMMO-GRAPHY	ROUTINE RADIOLOGY	ULTRASOUND NON OB/GYN	RADIATION THERAPY	NUCLEAR MEDICINE	CT SCAN	MRI	MRA	COMMENTS
AMERIHEALTH INS ofNJ Facility ID #004566 Provider Services: 1-800-821-9412 Member Services 1-800-877-9829	Referral Required if UMDNJ is the CAP site Pre-cert required if UMDNJ is NOT the CAP site	Referral Required if UMDNJ is the CAP site Pre-cert required if UMDNJ is NOT the CAP site	Referral Required if UMDNJ is the CAP site Pre-cert required if UMDNJ is NOT the CAP site	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	The initial referral to Specialists is needed Specialist can then do Radiology services based upon guidelines
CIGNA HEALTHCARE Facility ID# 221775306 Provider Services 1-800-244-6224 Member Services: 1-800-882-4462 Recertification: 1-800-244-6224	Manage Care & POS Plans Are Excluded Must Contact Medical Management Department See back of patient Identification Card PPO Plans	Manage Care & POS Plans Are Excluded Must Contact Medical Management Department See back of patient Identification Card PPO Plans	Manage Care & POS Plans Are Excluded Must Contact Medical Management Department See back of patient Identification Card PPO Plans	Manage Care & POS Plans Are Excluded Must Contact Medical Management Department See back of patient Identification Card PPO Plans	Manage Care & POS Plans Are Excluded Must Contact AIM’S @ (American 1-800-859-5288 PPO Plans	Manage Care & POS Plans Are Excluded Must Contact AIM’S @ (American 1-800-859-5288 PPO Plans	Manage Care & POS Plans Are Excluded Must Contact AIM’S @ 1-800-859-5288 PPO Plans	Manage Care & POS Plans Are Excluded Must Contact AIM’S @ 1-800-859-5288 PPO Plans
EMPIRE Blue Cross Provider Services: 1-888-476-7245 Medical Management HMO&POS 800-841-2411 Medical Management PPO/EPO & Indemnity 800-982-8089	Script Required	Script Required	Script Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Empire Patients HMO & Point Of Service MRA & MRI Required Pre-Auth
Health Net (Formerly Physician Health Services (PHS) / First Option Facility ID # 221775306 Provider Services: 800-622-7708 Prior Authorization 800-438-7886	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required	Specialist MUST obtain Pre-Cert whenever required

MANAGED CARE ORGANIZATION	MAMMO-GRAPHY	ROUTINE RADIOLOGY	ULTRASOUND NON OB/GYN	RADIATION THERAPY	NUCLEAR MEDICINE	CT SCAN	MRI	MRA	COMMENTS
HORIZON BLUE CROSS and BLUE SHIELD Facility ID #310119 Provider Services: 1-888-666-2535 Member Services: 1-800-355-2583	HMO & POS Plans Require Referral PPO & Indemnity NO Referral Required	HMO & POS Plans Require Referral PPO & Indemnity NO Referral Required	HMO & POS Plans Require Referral PPO & Indemnity NO Referral Required	HMO & POS Plans Require Pre-Auth Referral Required PPO & Indemnity NO Referral Required	HMO & POS Plans Require Pre-Auth Referral Required PPO & Indemnity NO Referral Required	HMO & POS Plans Require Pre-Auth Referral Required PPO & Indemnity NO Referral Required	HMO & POS Plans Require Pre-Auth Referral Required PPO & Indemnity NO Referral Required	HMO & POS Plans Require Pre-Auth Referral Required PPO & Indemnity NO Referral Required	The initial referral to Specialist is needed Specialists can then do Radiology services using the same referral for one visit only.
HORIZON NJ HEALTH (formerly Horizon Mercy) Facility ID # 1015754 Provider Services: 1-800-682-9094 Member Services: 1-800-682-9090	Script Required	Script Required	Script Required	Pre-Auth Required	Script Required	Pre-Auth Required	Pre-Auth Required	Pre-Auth Required
GREAT WEST HEALTHCARE(formerly One Health Plan of NJ) Facility ID # 221775306 Provider Services: 1-800-644-9175 Member Services: 1-800-685-2020	Script Required	Script Required	Script Required	Script Required Must call and review plan to see if Authorization is required	Script Required	Script Required	Script Required	Script Required	Specialist CANNOT give referral to other specialists
QUALCARE Facility ID# 221775306 Provider Service: 800-992-6613	PPO Script Required HMO/POS Referral Required	PPO Script Required HMO/POS Referral Require	PPO Script Required HMO/POS Referral Require	PPO Script Required HMO/POS Referral Require	PPO Script Required HMO/POS Referral Require	Pre-Cert Required	Pre-Cert Required	Pre-Cert Required	Primary Care or Specialist can give Referral

MANAGED CARE ORGANIZATION

MAMMO-GRAPHY

ROUTINE RADIOLOGY

ULTRASOUND NON OB/GYN

RADIATION THERAPY

NUCLEAR MEDICINE

CT SCAN

MRI

MRA

COMMENTS

UNIVERSITY HEALTH PLANS

Facility ID # 349

Provider Services: 1-800-780-2438

Member Services
1-800-564-6847

Script Required

The need for ultrasound must be noted on referral

Script
Required

Script Required

Pre-Cert Required

The initial referral to Specialists is needed

Specialist can then do Radiology services based upon guidelines

WELL CHOICE

Provider Service:
1-888-476-7245

Medical Management HMO 800-441-2411

Medical Management PPO 800-982-8089

Medical Management
Indemnity

800-548-0120

Script Required

Script
Required

Pre-Cert Required

Specialist can refer for Radiology Services but must obtain Pre-Cert for HMOs Patients