Insurance Referral and Pre-certification Requirements

Payer Service Type Requires Authorization Telephone Plan Type Network
Aetna Radiology         

Hospital inpatient

Hospital outpatient

Mental health/inpatient/outpatient

MRI, PET, CT, MRA, Nuclear Medicine and Cardiology          

All inpatient services

Outpatient surgeries are according to group, plan and codes


Radiology: 888-693-3211          

Hospital inpatient: 888-632-3862 or number listed on patient's card

HMO/POS/PPO Plans just using the Aetna network need to be called. Please call number listed on insurance card. 
AmeriHealth Radiology         

Hospital inpatient

Hospital outpatient

Mental health/inpatient/outpatient

MRI, PET Scan, CT, MRA, Nuclear Medicine and Cardiology         

All inpatient services

Outpatient surgeries are according to plan

Some services not covered for alliance members

Effective July 1, 2014, contact National Imaging Association (NIA) for prior authorization for the following non-emergent, advanced outpatient imaging services:         

  • CT/CTA
  • MRI/MRA
  • PET Scan
  • CCTA
  • Nuclear Cardiology/MPI

To obtain authorization, go to the NIA website or call the NIA dedicated toll-free phone number at 1-800-424-5657.

All other services, please call 800-408-7510. Not all services are covered for alliance members
Medicaid/Alliance Only accepted in Washington, DC.
BCBS/Local Radiology         

Hospital inpatient

Hospital outpatient

Mental health/inpatient/outpatient

MRI, PET Scan, CT, MRA, Nuclear Medicine and Cardiology         

All inpatient services

Outpatient surgeries are according to group, plan and codes

For all services: 800-443-5434 or 866-773-2884, option 1         

Mental health: 800-245-7013 or 866-773-2884, option 6 

HMO/PPO/POS All out of state BCBS plans need to be called for everything. This includes plans using the BCBS network.
Cigna Radiology         

Hospital inpatient

Hospital outpatient

Mental health/inpatient/outpatient

MRA, PET, CT, MRA, Nuclear Medicine and Cardiology         

All inpatient services

Outpatient surgeries are according to group, plan and codes

Radiology: 888-693-3211         

Hospital inpatient: 800-244-6224 or number listed on patient's card

HMO/POS/PPO Plans just using the Cigna network need to be called. Please call number listed on insurance card.
Tricare Radiology         

Hospital inpatient

Hospital outpatient

Mental health/inpatient/outpatient

All services 877-874-2273. All beneficiaries with Prime Benefits require approval. Most standard beneficiaries are ok for services.  All carriers/HMO Plans just using the Tricare network need to be called. Please call number listed on insurance card.
Trusted Radiology         

Hospital inpatient

Hospital outpatient

Mental health/inpatient/outpatient

MRI, PET Scan, CT, MRA, Nuclear Medicine and Cardiology         

All inpatient services

Outpatient surgeries are according to plan

Some services not covered for alliance members

All services require approval. Please call 800-821-1132. There is a prior authorization fax form on the Trusted website that needs to be submitted to request approval. Medicaid/Alliance Only accepted in Washington, DC.
United Healthcare Radiology         

Hospital inpatient

Hospital outpatient

Mental health/ inpatient/outpatient

MRI, PET Scan, CT, MRA, Nuclear Medicine and Cardiology         

All inpatient services

Outpatient surgeries are according to group, plan and codes

Radiology, including Nuclear Medicine and Cardiology: 866-889-8054         

All other services: 877-842-3210

HMO/PPO/POS Plans just using the UHC network need to be called. Please call number listed on insurance card.

 

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