Insurance
Precertification / Referrals
Since insurance requirements frequently change, patients should call their carrier to insure coverage of all medical procedures. The following is a list of insurances known to require authorization for Radiology exams. Please give our Tax ID # (133425028) when verifying coverage or obtaining authorization as our listing (Doctor-Facility) may vary by insurance carrier. If you have any questions about precertification or insurance referrals, please email us at authorizations@lenrad.com.
Insurances that Require Precertification and Insurance Referrals
Please note: (This is not a complete list of insurances in which we participate)
1199
All members require prior approval for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans from CaretoCare(888-910-1199).
1199 Homecare Benefit Fund/Fidelis
Precertification required for PET-CT scans. Please call (888-343-3547).
32BJ EMPIRE BCBS
All members require precertification for MRI/MRA, CT/CTA and PET-CT scans from AIM (877-430-2288).
AETNA
Precertification requirements vary per plan. You must call Aetna Provider Services (888-632-3862, option 2) for guidelines. Precertification may be required for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National. Out-of-state plan precertification requirements may be different from New York-based plans, please contact Aetna.
AFFINITY
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National [866-242-5615); (www.carecorenational.com)].
AMERICAN POSTAL WORKERS UNION (APWU)
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareAllies (800-582-1314).
AMERIGROUP/CAREPLUS
All members require precertification for MRI/MRA, CT/CTA and PET-CT scans via NIA (800-642-7565).
AMERIHEALTH
Members may require precertification for MRI/MRA, CT/CTA and PET-CT scans via American Imaging Management (800-275-2583).
AMERIHEALTH ADMINISTRATORS
Precertification requirements vary per plan. Please call the phone number on the member's card for precertification guidelines.
AMIDACARE (formerly VIDACARE)
Precertification required for MRI/MRA and PET-CT scans from Utilization Management (888-364-6061 option 1). All otherexams require an in-network referral.
ANTHEM/BLUECROSS BLUESHIELD
Precertification requirements vary per plan. Please call the phone number on the member's card for precertification guidelines.
BLUECROSS BLUESHIELD
Precertification requirements vary per plan. Empire BC/BS plans may require precertification for MRI/MRA, CT/CTA, and PET-CT scans via AIM (877-430-2288) or Medical Management (800-982-8089). For out-of-state BCBS plans, please call the phone number on the member's card for precertification guidelines. If you do not have the member’s card but have the alpha-prefix ID, you can call the Blue line (800-676-2583, option 4) and your call will be forwarded to the health plan.
CENTERCARE (MERGED WITH FIDELIS)
Please call Fidelis (888-343-3547)
CIGNA
Precertification requirements vary per plan. Please call the phone number on the member’s card for precertification guidelines. All Cigna plans with PHS+ as the Medical Management Level require precertification for MRI/MRA, CT/CTA and PET-CT scans via MedSolutions [(888-693-3297); https://cigna.medsolutionsonline.com]
EASY CHOICE HEALTH PLAN OF NEW YORK
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans, Ultrasound-guided FNA/ Biopsy procedures, Stereotactic Breast Biopsy and pregnancy-related US scans through Easy Choice’s Medical Management (800-270-9072). Please call our Verifications Department (ext 2004) for the list of CPT-codes for Ultrasound-guided FNA/Biopsy and Stereotactic Breast Biopsy procedures. Please keep in mind that precertification requests may take up to 3 business days once all clinical information has been submitted.
ELDERPLAN
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CaretoCare (866-390-7526).
EMPIRE GOVERNMENT PLAN (NYSHIP)
All members require notification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via the Empire Plan Notification Line (888-333-9067).
FIDELIS CARE
Precertification required for PET-CT scans and 4th or more OB Ultrasounds. Please call (888-343-3547).
GEHA
All members require precertification for MRI/MRA, CT/CTA, PET-CT scans through MedSolutions (866-879-8317.
GHI PPO and HMO
Most members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National [(800-835-7064); (www.carecorenational.com)].
GHI NETWORK ACCESS
Precertification requirements vary per plan/group. Please call the phone number on the member’s card for precertificationguidelines. Generally speaking, MRI/MRA, CT/CTA, PET-CT, Nuclear Medicine scans and Ultrasound-guided FNA/Biopsy and Stereotactic Breast Biopsy procedures will require precertification. Please call our Verifications Department (ext. 2004) for the list of CPT-codes for Ultrasound-guided FNA/Biopsy and Stereotactic Breast Biopsy procedures.
GREAT WEST
All members require precertification for MRI/MRA, CT/CTA and PET-CT scans via MedSolutions[(888-693-3295); (www.medsolutions.com)].
HEALTHFIRST (All Plans)
All members require precertification for MRI/MRA, CT/CTA and PET-CT and Nuclear Medicine scans via CareCore National [(877-773-2884); (www.carecorenational.com)].
HEALTH PLUS
All members require precertification for MRI/MRA, PET-CT scans, and Ultrasound-guided FNA/Biopsy and Stereotactic Breast Biopsy procedures, please call (800-450-8753). Please call our Verifications Department (ext. 2004) for the list of CPT-codes for Ultrasound-guided FNA/Biopsy and Stereotactic Breast Biopsy procedures before calling for precertification.
HIP
All HIP Fee-for-Service members in HMO, POS, Medicaid, Medicare, Child Health Plus, Family Health Plus benefit plans require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National [(866-417-2345); (www.carecorenational.com)]. Some plans may be capitated to a particular HIP Center in which case precertification or referrals must be obtained through the center. Some plans may require precertification via the Lenox Hill Healthcare Network (800-633-0695) or HIP Medical Management (888-447-2884). Electronic referrals are required for all HMO policies as well as some POS/PPO policies. Referrals are not required for routine mammography screening, HIP Access I and II plans and EPO/PPO members.
HIP CMO
For members whose PCPs are capitated to the CMO/Montefiore network, precertification will be required for MRI/MRA and PET-CT scans and notification will be required for CT/CTA and Nuclear Medicine scans, please call (877-447-6668).
HIP HEALTHCARE PARTNERS (FORMERLY HERITAGE)
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans. Please call (888-746-2200). All exams that do not require precertification will require referrals including x-ray, ultrasound and mammography exams.
HUMANA (CHOICE CARE ONLY-through PHCS)
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via HealthHelp (866-825-1550).
MEDICAID
Please verify Medicaid eligibility to ensure member's coverage is not through a Managed Care plan via eMedNY or the Medicaid Verification System through OMNI. All Fee-For- Service Medicaid members who are not enrolled in a Managed Care plan, require prior approval for MRI/MRA, CT/CTA and PET-CT scans from RadConsult™ administered by HealthHelp (888-209-4122). Medicaid members who've selected a Managed Care plan may require precertification from the respective utilization management entities.
MERITAIN
Precertification requirements vary per plan. Please call the phone number on the member’s card for precertification guidelines.
METROPLUS
For the Medicaid plan, precertification is not required for out-patient radiology exams. For the Medicare plan, precertificationis required, please call (800-303-9629).
MULTIPLAN
Precertification requirements vary per plan. Please call the phone number on the member's card for precertification guidelines.
MVP
Certain MRI/MRA, CT/CTA, PET-CT scans require precertification. Please call the phone number on the member's card for precertification guidelines.
NEIGHBOURHOOD HEALTHPLAN
Precertification is required for all MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via Neighborhood Care Coordination Department, please fax requests (800-338-4195) or submit via NHP web portal (www.getnhp.com).
OXFORD
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans and 3rd or more OB Ultrasounds via CareCore National [(877-773-2884); (www.carecorenational.com)]. Some plans may be capitated to CMO network and will require precertification via CMO (800-876-7455). Please note that Doppler studies (Carotid and Extremity), arthrograms and biopsy procedures require an electronic Oxford referral for all Oxford members except those with non-gated policies.
PERFORMAX
All members require precertification for MRI/MRA, CT/CTA, PET-CT scans, please call (800-337-0506).PHCSPrecertification requirements vary per plan. Please call the phone number on the member's card for precertification guidelines.
PHS/HEALTHNET
Plans which may be capitated to the CMO network and will require precertification via CMO (888-666-8326). Some out-of-state plans require precertification via NIA (888-899-7804).
PRINCIPAL FINANCIAL GROUP
All members (except self-funded policies) require prior approval for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scansfrom NIA (888-899-7805).
TOUCHSTONE HEALTH
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via Care-to-Care (888-324-9891). All members require electronic referral authorization for X-rays, Mammograms, Ultrasounds, Ultrasound-guided FNA and Biopsy procedures, Stereotactic Breast Biopsy via Healthcare Partners (888-777-0204). Please call our Verifications Department (ext 2004) for the list of CPT-codes for Ultrasound-guided FNA/Biopsy and Stereotactic Breast Biopsy procedures. Please keep in mind that requests for referral authorizations may take up to 3 business days once all clinical information has been submitted to Healthcare Partners.
UMR (by United Healthcare)
Precertification requirements vary per plan. Please call the phone number on the member’s card for precertification guidelines.
U.S. FAMILY HEALTH PLAN
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans. Please call [(866-390-0933); www.medsolutions.com]
UNICARE
Some members require prcertification for MRI/MRA, CT/CTA Scans, PET-CT and Nuclear Medicine scans. Please call (800-288-8630) to verify precertification requirements.
UNITED HEALTHCARE
New York-based plans do not require precertification for outpatient diagnostic studies. If the referring doctor is from New Jersey, precertification is required via CareCore National [(800-818-8307); (www.carecorenational.com)].
UNITED HEALTHCARE COMMUNITY PLAN (formerly Americhoice)
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National [(866-889-8054);(www.carecorenational.com)].
UNITED HEALTHCARE: Medicare Solutions (AARP, SECURE HORIZONS, EVERCARE)
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National [(866-889-8054);(www.carecorenational.com)].
VNS CHOICE SELECT
Precertification required for MRI/MRA, CT/CTA, PET-CT, Nuclear Medicine scans from VNS Medical Management (866-791-2215). Please keep in mind that precertification requests may take up to 2 business days once all clinical information has been submitted.
WELLCARE
All members require precertification for MRI/MRA, CT/CTA, PET-CT and Nuclear Medicine scans via CareCore National[(888-333-8641); (www.carecorenational.com)].
BILATERAL PROCEDURES
Bilateral procedures usually require two separate approval numbers, unless if the insurance company usually approves multiple exams under one number. For CareCore National cases, any bilateral extremity (hips, knees, ankles, feet, shoulders, wrists, hands, elbows) being ordered by the doctor must have two separate approval numbers. CareCore National usually issues only one approval number for the MRI of bilateral hips if the approval for both hips is called in or obtained during the same phone call. However, obtaining one approval number for MRI of bilateral hips usually creates a claims issue - the claim for one of the MRI hip will be denied. We strongly advise you to call or create online approvals for each hip separately.
OB ULTRASOUNDS
OB Ultrasounds, in excess of 3 per pregnancy may require precertification. Please call the patient’s health plan for requirements.
LIEN
We will accept a Lien agreement on all open/active cases. Patients must provide attorney information before services are rendered. To reach our Lien Department, please dial our main number, 212-772-3111, extension 1432 to reach Raymond Medina.
NO-FAULT
All No-fault patients must bring accident/insurance information and attorney information. Please call our No-fault office to confirm insurance information. To reach our NF Department, please dial our main number, 212-772-3111, extension 1432to reach Raymond Medina.
WORKERS COMPENSATION
All Workers Compensation procedures must be verified before the exam is performed. Please be sure to have the patient’s workers compensation carrier information including the name, address, telephone number, claim number, and the adjuster’s name along with the workers compensation board case number. It is also necessary to provide the employer name and date of injury. Prior authorization may be required for MRI /MRA scans in some cases. Most workers compensation carriers now require radiological testing to be scheduled through their preferred individual networks. It is important that any scheduled testsmust be for the specific established injury site. Any tests to be performed on a non-established injury site will need to first be approved by the WCB. This process can sometimes take up to 4 weeks. For additional information regarding radiology testing, the individual carrier should be contacted directly. To reach our WC Department, please dial our main number, 212-772-3111, extension 1413 to reach Monica Kelly.
