Office of Managed Care Operations

University Hospital Referral Requirements for HMOs

Outpatient Services

X= Requires referral

*  After 1st annual visit

Managed Care Organization	Specialist Visit	OB/GYN Visit	Non-EmergentAmbulance (Transport))	MRI	Ultra-Sound (Non OB related)	CT Scan	Rehab	Mental Health Svcs.
Aetna	X	X	Pre-Auth	Pre-Auth	X	Pre-Auth	Pre-Auth	Contact Magellan Behavioral Health 1-800-424-4506
AMERIGROUP (AMERICAID)	Script	---	Pre-Auth	Pre-Auth	X	Pre-Auth	Pre-Auth	Not Covered
AMERICHOICE (formerly Managed Healthcare Systems )	X	X	Pre-Auth	Pre-Auth	X	Pre-Auth	Pre-Auth	Not Covered
AMERIHEALTH	X	---	Pre-Auth	Pre-Auth	X	Pre-Auth	X	Self-Referred
Cigna HealthCare	HMO & POS Not Covered   PPO COVERED	HMO & POS Not Covered   PPO COVERED	HMO & POS Not Covered   PPO COVERED	HMO & POS Not Covered Must Contact Aim’s Customer Service @ 1-800-252-2021	HMO & POS Not Covered Must Contact Aim’s Customer Service @ 1-800-252-2021	HMO & POS Not Covered Must Contact Aim’s Customer Service @ 1-800-252-2021	HMO & POS Not Covered   PPO COVERED	Contact Cigna Behavioral Health @800-926-2273
Empire Blue Cross/Well Choice	X	X	Pre-Auth	Pre-Auth	Script Required	Pre-Auth	Pre-Auth	Call MH
Health Net ( formerly Physician Health Services & First Option)	X	X	Pre-Auth	Pre-Auth Contact 888-642-4810	Pre-Auth	Pre-Auth Contact 888-642-4810	Pre-Auth	Call MHN 1-800-728-9899
Horizon Blue Cross & Blue Shield of NJ	X	---	Pre-Auth	Pre-Auth	X	Pre-Auth	Pre-Auth	Call Green Springs800-626-2212
Horizon NJ Health (formerly Horizon Mercy )	X	---	Pre-Auth	Pre-Auth	Pre-Auth	Pre-Auth	Pre-Auth	Not Covered For Behavioral Health for Division of Developmental Disabilities Must Contact Magellan Behavioral Health @ 877-695-5612
Great West Health Care (formerly One Health Plan)	Script	Script	Script	Script	Script	Script	Script	Pre-Auth Call MH
Qualcare	X	X	Pre-Auth	Pre-Auth	Pre-Auth	Pre-Auth	Pre-Auth	Call MH Pre-Auth
University Health Plans	Pre-Auth	Pre-Auth	Pre-Auth	Pre-Auth	Script	Pre-Auth	Pre-Auth	Call MH Pre-Auth

Who should use this website	Managed Care Glossary of Terms
Disclaimer	Get More Information

Last Reviewed:

July 2005

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