Updated 7/05/12 MNN

Radiology Authorization Grid- applicable to SH Grand Rapids locations for facility services only

INSURANCE / PET / ULT / MRI/MRA / NUC/CARDIAC STUDIES / CAT / Authorization Contact
AETNA (includes medicare adv plans) / DEPENDS ON GROUP / DEPENDS ON GROUP / YES / YES / YES / MedSolutions: 888-693-3211
AMERICAN MED SECURITY / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / *Obtain at time of benefit verification
ASR/ ASR PHYSICIANS CARE / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / *Obtain at time of benefit verification
ASSURANT HEALTH / YES / NO / YES / NO / NO / *Obtain at time of benefit verification
BCBS PPO (excluding medicare plus blue ppo) / YES / NO / YES / YES / YES / AIM: 800-728-8008 or online
BCBS OUT OF STATE / VARIES BY STATE / VARIES BY STATE / YES / YES / YES / *Obtain at time of benefit verification
BCN (includes medicare adv) / NO / NO / YES / YES / YES / 800-392-2512
CARE RESOURCES / YES / YES / YES / YES / YES / Nurse Line: 616-913-2008
CARESOURCE MEDICAID / NO / NO / YES / NO / NO / Med Mgt: 800-390-7102
CIGNA / YES / DEPENDS ON GROUP / YES / YES / YES / Cigna: 800-882-4462
COFINITY ‘OTHER’ / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / *Obtain at time of benefit verification
CONTINENTAL GENERAL (WHEN NOT 2ND TO MCARE) / DEPENDS ON PLAN TYPE / DEPENDS ON PLAN TYPE / DEPENDS ON PLAN TYPE / DEPENDS ON PLAN TYPE / DEPENDS ON PLAN TYPE / *Obtain at time of benefit verification
GEHA / YES / NO / YES / YES / YES / MedSolutions: 866-879-8317
GRAND VALLEY HEALTH PLAN / YES / YES / YES / YES / YES / *Obtain at time of benefit verification
GREAT WEST HEALTH / YES / NO / YES / YES / YES / *Obtain at time of benefit verification
GROUP MARKETING / YES / YES / YES / YES / YES / 269-343-2611 prompt #2
HAP / YES / YES / YES / YES / YES / HAP: 313-664-8950
HUMANA (includes Medicare Choice and HMO plans) / YES / YES / YES / YES / YES / HealthHelp: 877-883-5689
IONIA HEALTH PLAN CAID / YES / NO / NO / YES / NO / 866-291-8691
KENT HEALTH PLAN
A & B / YES / NO / YES- need auth 72 hours pre-procedure / YES- only covered with cancer dx / YES- need auth 72 hours prior / 866-291-8691
MCLAREN MEDICAID / YES / YES / YES / YES / YES / 888-327-0671 *PCP should obtain, unless unavailable*
MEDICAID ‘OTHER’ HMO / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / *Obtain at time of benefit verification
MEDICARE ‘OTHER’ / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / VARIES BY PLAN / *Obtain at time of benefit verification
MOLINA MEDICARE (medicare adv and dual eligibles only) / YES / NO / YES / YES- Cardiac NUC / YES / 888-898-7969 *prompts 1,4,2- rep will transfer for medicare patients
PHYSICIANS HEALTH PLAN (PHP- including medicare plans) / YES / YES / YES / YES / YES / PHP: 800-832-9186
PRIORITY HEALTH (including medicaid and medicare plans) / YES / NO / YES / YES / YES / AIM: 800-552-0020 or online
SECURE ONE / YES / YES / YES / YES / YES / Health Plan Advocate:
888-375-8909
TENCON HEALTH PLAN MEDICAID / NO / NO / NO / YES / NO / 866-291-8691
TRICARE (Prime plans only) / YES / YES / YES / YES / YES / Tricare: 877-874-2273
TRUSTMARK / YES / NO / YES / YES / YES / MedSolutions: 800-537-8275
UNITED HEALTHCARE & MEDICARE SECURE HORIZONS / YES / NO / YES / YES / YES / UHC Radiology: 866-889-8054 or Online UHC
U.P. MEDICAID / YES / YES / YES / YES / YES / 888-904-7526
VETERANS ADMIN. / YES / YES / YES / YES / YES / 269-966-5600
NUC only: Ken@ ext 1328
CT/MRI/ULT: Laura@ ext 31371
WAUSAU / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / DEPENDS ON GROUP / CareMgt: 866-586-0590
WORKERS COMP / YES / YES / YES / YES / YES / *Approval through adjuster