Baystate Accepted Insurances

1-800-258-4674 Ext. 3355

Referral Requirements for All Baystate MRI & Imaging Centers

Booking Diagnosis All services must be requested in writing and include the booking diagnosis (rule out, possible, question of, suspected, follow-up, status post is not acceptable for a booking diagnosis)

Insurance Authorization Information current as of January 31, 2008

Insurance Carrier	Authorization Necessary	Requirement	Pre-Authorization Phone Number
All Commercial Insurance Plans	Based on the Pt's Insurance Plan	Advise to contact insurance co. for plan requirements/authorizations prior to scheduling appointment	Phone number can be located on the patients insurance card. Customer Service#
Aetna/USHC	Yes (effective 05/01/07) All plans except Indemnity Traditional Choice plans Authorizations are valid for 90 days	Referring MD required to obtain authorization. To verify if required: HMO plans 800-624-0756 PPO plans 800-632-3862	MedSolutions 1-888-693-3211 http://www.medsolutions.com/
Allmerica	Based on the Pt's Insurance Plan	Individual employer plans may require prior authorization, referring physician can contact medical review unit	1-800-834-8647
APWU - American Postal Workers Union	Yes	Referring MD required to obtain authorization prior to scheduled appointment	Contact Med Solutions 888-693-3298 http://www.medsolutions.com/
BCBS MA (HMO) (POS)	Yes Authorizations are valid for 60 days	Referring MD required to obtain authorization prior to scheduled appointment	http://www.americanimaging.net AIM 866-745-1783
BCBS Out of state plan Ex. (YGP)	Plan locator via ID Prefix 1-800-676-2583 option 5	Referring MD to call plan locator to determine if auth is needed prior to scheduled appointment.	Based on plan locator instructions
BMC Healthnet	Yes (effective 03/01/08)	Referring MD required to obtain authorization prior to scheduled appointment	Contact Med Solutions 888-693-3211 http://www.medsolutions.com/
Bricklayers	Depends on plan type	Check Card for detailed information	Phone# can be located on the patient's insurance card
Carelink	Yes	Referring MD required to obtain authorization prior to scheduled appointment	CIGNA HealthCare 1-800-244-6224
CIGNA & Healthsource	Yes Auth's are valid for 90 days. Plans may require registration# only	Referring MD required to obtain authorization prior to scheduled appointment	Contact Med Solutions 888-693-3211 http://www.medsolutions.com/
Commonwealth Care - *BMC*	Yes (effective 03/01/08)	Referring MD required to obtain authorization prior to scheduled appointment. Patients must be scheduled in a location that is contracted with BMC.	Locations as follows; Brockton, FR/NB, Weymouth, Boston, Brighton, Cape, UMass, Baystate, Marlboro, Framingham, St. Luke's Med Solutions 888-693-3211
Connecticare	Yes Auth are valid for 30 days	Referring MD required to obtain authorization prior to scheduled appointment	Call NIA 877-607-2363 http://www.radmd.com
Fallon Community Health Plan	Yes Authorization is required (effective 02/01/08)	Referring MD required to obtain authorization prior to scheduled appointment	Contact Med Solutions 888-693-3211 http://www.medsolutions.com/
GEHA	Yes	Referring MD required to obtain authorization prior to scheduled appointment	1-866-879-8317
GIC Unicare Commonwealth PPO UNICARE Plan Locator# 888-234-8850	Yes Auth's are valid for #1 date of service	Referring physician required to obtain authorization for MRI or CT of the following scans only: Abdomen Pelvis & Prostate Lumbar Thoracic Spine Chest/Thoracic Cavity Cervical Knee ***GIC requires 3 business days for approval process to be completed. Imaging can be performed on the 4th day if approved.	GIC 1-800-442-9300
Great West	Yes Auth are good for 90 days	Referring MD required to obtain authorization prior to scheduled appointment	Call Med Solutions 888-693-3211 http://www.medsolutions.com/
Harvard Pilgrim	Yes Auth are good for 30 days	Referring MD required to obtain authorization prior to scheduled appointment	Call NIA 800-642-7543 http://www.radmd.com
Health Care Value Management (HCVM)	Based on patients insurance Plan	Advised to contact Insurance co. for plan requirements/authorizations prior to scheduled appointment	Phone # can be located on the patients insurance card. Customer Service #
Health New England	Yes Auth are valid for 60 days	Referring MD required to obtain authorization prior to scheduled appointment	NIA 888-642-4815 http://www.radmd.com
HealthPlans, Inc.	Depends on Group	Eligibility #800-532-7575	Call to Verify w/Health Plan
Mass Health Medicaid	NO (With the exception of TMJ and Breast Scans require Pre-approval)	Referring MD to mail an authorization form to Mass Health. Requires 21 day notification prior to imaging.	Please call Shields at 1-800-258-4674 ext 5265 to obtain authorization form or visit www.masshealth'apas.com
Mass Laborer's	No	N/A	N/A
Medicare	Scan must meet Medical Necessity Guidelines	Call Shields IVU Staff if assistance is required	1-800-258-4674 ext. 5265
MM HealthCare - Medicare of Puerto Rico Replacement HMO	Yes	Referring doctor to obtain	866-620-2377
Medex	No	N/A	N/A
Multiplan	Based on patients insurance Plan	Advised to contact Insurance co. for plan requirements/authorizations prior to scheduled appointment	Phone # can be located on the patients insurance card. Customer Service #
Motor Vehicle Accidents	Health Insurance Authorization may be required based on PIP availability.	Advised to contact Insurance co. or Atty. to verify PIP availability. If exhausted, follow the guidelines of the patient's private health insurance.	Based on the patient's MVA Insurance Company.
Neighborhood Health Plan	Yes Auth are valid for 90 days	Referring MD required to obtain authorization prior to scheduled appointment	Call Med Solutions 1-888-693-3211 http://www.medsolutions.com/
New England Carpenters	No	N/A	N/A
Oxford Health Plan	May be required based on CPT/Scan Type	Advised to contact Insurance co. for plan requirements/authorizations prior to scheduled appointment	Phone # can be located on the patients insurance card. Customer Service #
Private Health Care Systems (PHCS)	Based on patients Insurance Plan	Advised to contact Insurance co. for plan requirements/authorizations prior to scheduled appointment	Phone # can be located on the patients insurance card. Customer Service #
Pinnacle Health	Yes Auth are valid 1 specified date of service	Referral required from PCP prior to scheduled appointment	Referral management 508-495-1191 or or 508-775-7785
Tricare	No	N/A	N/A
Tufts	Yes Auth are valid for 60 days	Referring MD required to obtain authorization prior to scheduled appointment	Call NIA 866-642-9703 http://www.radmd.com
Tufts Secure Horizons(Medicare Preferred)	No	N/A	N/A
UFCW-HCVM	Yes	Referring MD required to send a letter of Medical Necessity via fax to the Medical Director at UFCW. Requires 7-10 business days for approval to be processed. (HTH)	Phone# 888-773-8329 FAX# 201-569-1085
United Health Care	Yes - Eff 05/0707 MA Effective dates TBA for RI	Referring MD required to obtain notification# through CareCore	866-889-8054 Phone 866-889-8061 Fax www.unitedhealthcareonline.com
W/C	Yes	UR/pre-certification required; referring doctor to obtain	See UR card
*All insurance referral information is subject to change at any time. *****