UH - Managed Care Office

Office of Managed Care Operations

Referral Requirements for Home Health Services & Durable Medical Equipment

Managed Care Organization

Durable Medical Equipment

Home Health Services

Department & Telephone
# for Precertification

Company other than
HMO
to call for Precertification

	*AETNA*

Pre-Auth

Pre-Auth

Must Contact
Medical Management
to verify if Pre-certification is required for these services. Must also contact the benefits department to verify that the patient has coverage
1-800-624-0756
.

AMERIGROUP

Community Care

Pre-Auth

Pre-Auth

Case Management
1-800-454-3730
Fax 1-800-964-3627:

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	Unity Healthcare Community Care

Pre-Auth

Pre-Auth

Health Services
888-362-3368
Fax: 1-800-766-2597

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Empire Blue Cross
Well Choice

Pre-Auth

Pre-Auth

Medical Management

HMO/POS
1-800-441-2411

EPO/PPO
1-800-845-4741

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Horizon
Blue Cross
& Blue Shield (PPO/POS/HMO/Indemnity)

Pre-Auth
Depends on Patient
Contract

Pre-Auth
Depends Patient Contract

Must Contact
Horizon Blue Cross to Verify if the Patient has type of Coverage on plan.
Each Plan
is Benefit Driven
Must Contact:
1-888-666-2535

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Horizon NJ Health

Pre-Auth
Depends
on Patient Contract

Pre-Auth
Depends
on Patient Contract

Utilization / Case
Management
Department
1-800-682-9094

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QUALCARE

Depends
on Patient's
Contract

Depends
on Patient's
Contract

Utilization Management

QUALCARE
PPO
800-992-6613

QUALCARE
HMO/POS
800-254-0130

QUALCARE
Precertification
Fax Number:
1-732-562-1023

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Note: Horizon NJ Health DME/Prosthetics (with charges equal to or greater than $100)

Note: AMERIGROUP: No precertification is required for coverage of Glucometers and nebulizers, dialysis and end stage
renal disease equipment, infant photo/light therapy. All Durable Medical Equipment (DME) billed with an RR modifier 9rental0 requires precertification.
AMERIGROUP NJ Family Care D: No Coverage for Medical Supplies except for diabetic supplies and an initial prosthesis or repair and hearing aids for NJ Family Care D Members are covered for members age 15 and younger, but limited to $1,000 per ear every 24 months. :

Note: Great West Health Care Contract Terminated with University Hospital as of 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 as November 9, 2010

Note: HEALTHNET Insurance Company Medicaid Products was 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

Note: AETNA Beginning August 12, 2011 if the referring Physician does not obtain precertification,

Aetna will no longer cover at the in-network benefits level for services provided by nonparticipating
Radiologists, Pathologies, Anesthesiologists, and Independent Laboratories

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Last Reviewed:July 2011
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150 Bergen Street
Newark, NJ 07103 USA
(973) 972 - 4300