Referral Requirements for UMass Memorial MRI & Imaging Center

Booking Diagnosis (information current as of January 1, 2008) 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  - Tax ID Number 04-3454298 All Pre-Authorization and Pre-Certifications must be requested for UMass Memorial MRI & Imaging Center, referencing the tax ID number. The location of the UMass Memorial MRI & Imaging Center should also be specified.  Authorizations requested without specifying UMass Memorial MRI & Imaging Center are directed to the hospital and are invalid at our facilities.

Fallon patients can only be scheduled at the Fitchburg and Leominster locations of UMass Memorial MRI & Imaging. Please reference Fallon's site specific vendor numbers when requesting insurance authorization.

Please specify if more than one MRI/MRA is being ordered when obtaining authorization

UMass Memorial MRI & Imaging Center Locations

Tax ID Number 04-3454298

       Shrewsbury Street - Worcester

 

       Belmont Street - Worcester
       Wing Memorial Hospital - Palmer

       Leominster Campus - Leominster

Fallon Vendor # 49816

       Burbank Campus - Fitchburg

Fallon Vendor # 49817


 

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 MedSolutions
1-888-693-3211
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
Patient must be scheduled on 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 (effective 02/01/08) Referring MD required to obtain authorization prior to scheduled appointment Call 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
Authorizations 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 the
MassHealth APAS Website 
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 specific 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 TBD 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. ***

 

Shields Health Care 1-800-258-4MRI (4674)

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