Insurance Plan
*Please note that some insurances are accepted for Early Intervention only |
Product Type
|
Precertification Requirements |
AETNA |
HMO/PPO/ Affordable
Health Choice |
HMO plans require referral from Primary Physician
2006
Aetna Precertification List. |
Alliance PPO/One Net PPO |
PPO |
None |
Amerigroup |
Medicaid -
Commercial Managed Care |
Required |
Anthem BlueCross BlueShield of VA & HealthKeepers and
HealthKeepers Plus/Famis |
HMO/POS/PPO/Indemnity /Medicaid
(note: Medicaid precert requirements are consistent with the HMO requirements) |
HMO/POS(HealthKeepers and HealthKeepers
Plus/Famis)/PPO/Indemnity
Anthem policy. |
CareFirst BlueCross BlueShield and BlueChoice |
HMO/POS/PPO/Indemnity |
HMO plans: referral is
required for first 3 visits |
Champus/Tricare Standard |
PPO |
Required. Prescription
must be obtained by patient. |
Champus/Tricare Prime |
HMO |
Authorization Required for all services. Pediatrician must input the prescription in
system for one year and renew every year |
CIGNA HealthCare |
HMO/POS/PPO/Indemnity |
HMO/POS/Open Access Plus :
PPO/Indemnity/EPO/PPA : Verify requirements on the back of
the patient's ID card or on the CIGNA web site. |
First Health/(CCN) |
PPO |
Depends on patient's benefits. |
Great West/One Health |
PPO |
Depends on patient's benefits. |
KAISER |
HMO/POS (Kaiser
Added Choice) |
HMO/PPO: Requied
Product
Information |
MAMSI |
HMO: MDIPA, Optimum
Choice
POS: MDIPA Preferred,
Optimum Choice, Preferred.
PPO/Indemnity: MAMSI Life &
Health
PPO:
Alliance (reference above) |
HMO/POS : Required for 6 months
MAMSI's precertification
form. |
Medicaid - VA
Note: FRC does not
participate with Amerigroup Medicaid - Authorization required for all
services. |
Government Plan |
Required after 5 visits . Prescription required from Pediatrician |
NCPPO (WellPoint, Unicare) |
PPO |
Effective DOS 6/18/07 for Unicare only : Precert Required for CT/CTA, MR,
Nuc Card, and PET. |
OneNet PPO |
|
Please reference Alliance PPO. |
PHCS |
PPO/POS |
Depends on patient's benefits. |
UNITED
HealthCare (Non-MAMSI Products) |
HMO/POS/PPO |
Precert required if 1) patient is under case management, or 2)
to confirm medical necessity. |