Insurance Referral and Pre-certification Requirements

Company/Patient Plan Type Insurance Referral and Pre-certification Requirements*
AARP   NONE
Advantage Health HMO NONE
AETNA Healthcare HMO, POS, Qpos, US Access, Open Access Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 800-918-8924

Pre-cert Web site: www.carecorenational.com

AETNA PPO NONE
AFSRA/Coventry   Member should contact the home plan listed on back of the card for precertification guidance.
APWU   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 888-693-3298

Bankers Life   NONE
BC/BS CareFirst Blue Choice HMO Blue Choice,     

POS, Indemnity,

dual option, Anthem PPO, HMO

Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact info: See phone number on back of insurance card

Pre-cert Web site: Varies by state

BC/BS Federal/Local PPO, Federal NONE
CIGNA HMO, Network, POS,    

PPA, Open Access,

Open Access Plus,

Flexcare

Precertification required for MRI, MRA, CT, CTA, PET/CT, Nuclear Medicine and HSG.    

Pre-cert contact info: MedSolutions, 1-888-693-3211

DC residents: 800-541-7256

Pre-cert Web site: www.medsolutionsonline.com

CIGNA PPO NONE
CareFirst   Member should contact the home plan listed on back of the card for precertification guidance.
Chartered Alliance/    

Chartered Health Plan/Health Right/

Health Right Alliance

  Referral needed for all radiology procedures.    

Pre-cert contact number: 202-408-4720

Crime Victims   NONE
DC Medicaid   Precertification required for PET/CT    

Pre-cert contact number: DelMarVa, 410-712-7416

Precert contact number: 800-999-3362

ElderCare Medicare HMO Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 800-556-1570

Pre-cert contact number (local): 410-864-4440

Embassy Liability   NONE
FCE Benefit Administrators   Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact number: 800-962-0643

Mail Handlers Coventry   Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact number: 800-410-7778

Great West   Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact number: 888-693-3295

HSCSN   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 202-463-2737

Health Payors Organization (HPO)   NONE
Humana   Precertification required for all Radiologic exams.    

Pre-cert contact number: 800-523-0023

Kaiser Permanente   Insurance referral required for all exams with the exception of screening mammograms.    

Pre-cert contact number: 800-810-4766

MAMSI/MDIPA/GEHA/Optimum Choice   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 800-342-6141

GEHA Pre-cert contact number: 888-693-3298

MD Medicaid   NONE
Medicare   NONE
National Capital PPO (Unicare)   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 866-714-1101

NALC   Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact info: 800-548-8454

One Net PPO Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact number: 800-342-6141

Peace Corps   NONE
Principal Financial Group   NONE
Tricare PPO Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert Web site: www.mytricare.com

United HealthCare of Mid-Atlantic POS, PPO Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 866-889-8054

Pre-cert Web site: www.unitedhealthcareonline.com

Unison/Unison Alliance   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 800-366-7304

Unicare   Precertification required for MRI, MRA, CT, CTA, PET/CT, and Nuclear Medicine.    

Pre-cert contact number: 866-714-1101

Pre-cert Web site: https://www.providerportal.com

VA Medicaid   NONE
VAN BREDA   Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact info: 800-962-6831

WAUSA Insurance   Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact info: 800-537-6662

Well Care Medicare HMO Member should contact the home plan listed on back of the card for precertification guidance.    

Pre-cert contact info: 866-235-2770

Workers Comp   NONE

 

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