If patient has a Medicaid plan that is a Family Planning program, they will need to be self pay. These plans are available in ALL states. So when running Simplicity, you need to look at the plan name (See example below). If plan name comes up as FP | Limited to family planning services, please let patient know that they need to be self pay and change insurance to self pay according to the state you are scheduling in.
Auth requirements:
Health Choice/Health Choice Generations: OB US is 5-7 days TAT, DUPLEX/DOPPLER is 5-7 day minimum TAT
Tricare: All US, MG, BD, MRI & CT require auth- 14 days minimum TAT
Alignment: US- 7 days minimum TAT
Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT (In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping and Prostate and out of network for ALL CT except CT lung, CTA for PE, CTA runoff and patients over 400 lbs.
Mercy Care/Mercy Care Advantage: US (Elastrography) cpt 76981 is a 14 day minimum TAT
Scan Health: ALL Breast Imaging - 7 day minimum TAT
Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.
Humana FL (Only) All modalities - Schedule 9 days out. Add-Ons ONLY allowed if patient has referral/authorization number on hand.
COMMONLY MISCHEDULED PROCEDURES
Irvine and Laguna Hills we are contracted with CalOptima effective 10/1/2021
Irvine NOT contracted with IEHP
Kaiser patients only contracted with:
Beverly Hills (Standup)
PRECISE IMAGING IS A COMPANY ACCOUNT NOT WC/LIEN
23357(Precise Imaging Tech Only-CA (SoCal Only)- USE FOR SCANS CONTAINING NO CONTRAST
23356 (Precise Imaging Global- CA(SoCal Only)- USE FOR ARTHROGRAMS AND X-RAY MRI CLEARANCE EXAMS
NPI: 1104321959 TIN: 943292479