AETNA- COMMERICAL & MEDICARE PLANS

AETNA BETTER HEALTH

AMERIGROUP

AMERIHEALTH- KEYSTONE AND INDEPENDENCE BC & 65 PLANS     

AMERIHEALTH ADMINISTRATORS, INDEPENDENCE ADMINISTRATORS, INSURANCE DESIGN ADMINISTRATORS (IDA), INSURANCE ADMINISTRATORS OF AMERICA (IAA) 

BRIGHTON / MAGNACARE (CALL BILLING BEFORE SCHEDULING)

CHAMP VA

CONSUMER HEALTH NETWORK (CHN)

CIGNA/GREAT WEST

 

CIGNA HEALTHSPRING (BRAVO- MEDICARE HMO)

CLOVER 

CONTINENTAL/AETNA LOGO

GEISINGER COMMERCIAL AND MEDICAID

HORIZON BC BS OF NJ COMMERCIAL AND MEDICARE PLANS

HORIZON NJ HEALTH

HORIZON NJ HEALTH TOTAL CARE   

 

HUMANA MEDICARE

HUMANA MILITARY (TRICARE)-AUTHORIZATION REQUIRED FOR PRIME MEMBERS

 

INTERGROUP

MEDICARE AND RAILROAD MEDICARE

MERITAIN 

*NOTE MULTIPLAN / PHCS PRIMARY NETWORK*

*** IF MULTIPLAN/PHCS IS NOT THE PRIMARY NETWORK AND THE CARD SHOWS PRACTIONER & ANCILLARY ONLY, CLAIM WATCHER OR IMAGINE HEALTH– CSC NEEDS TO GET A SINGLE CASE AGREEMENT BEFORE SCHEDULING PATIENTS (IF SCHEDULED THEY MAY NEED TO BE MOVED UNTIL THE CASE RATE IS APPROVED) -PLEASE CALL BILLING BEFORE SCHEDULING: 732-383-4164

 

***A CLEAR COPY OF THE INS CARD FRONT AND BACK NEEDS TO BE EMAILED OR FAXED TO LORI: LBREINING@PRACTICE-ALT.COM OR FAX 732-383-6840. ***

 

 

OCCUNET

OSCAR (MUST HAVE QUALCARE LOGO ON THE CARD)

OXFORD 

PRIME HEALTH SERVICES PPO & PRIME HEALTH SERVICES PFFS/MEDICARE 

QUALCARE

UMR 

UNIFORMED SERVICES FAMILY HEALTH PLAN 

UNITED HEALTHCARE COMMERCIAL AND MEDICARE

WELLCARE MEDICARE & MEDICAID

WELLNET

US DEPT OF VA VETERAN AFFAIRS / VETERANS HEALTH ADMINISTRATION

(VETERANS CHOICE, VETERAN AFFAIRS COMMUNITY CARE NETWORK (VACCN), VETERANS CHOICE PROGRAM (VCP) (ALL TESTS REQUIRE PRIOR AUTHORIZATION & REFERRAL

***CENTENNIAL SURGERY CENTER MUST BE LISTED ON BOTH THE AUTHORIZATION AND REFERRAL ***

 

UROLOGY OFFICES:

*PLEASE NOTE FOR ALL INTERSTIM PATIENTS (IPG GENERATOR, LEADS MEDTRONIC OR AXONICS IMPLANTS), CENTENNIAL SURGERY CENTER IS REQUIRED TO OBTAIN PRE-APPROVAL FOR MOST INSURANCE COMPANIES BEFORE SCHEDULING. ALSO BEFORE SCHEDULING MEDICAL NECESSITY REQUIREMENTS NEED TO BE MET.

 PLEASE EMAIL OR FAX CLINICAL DOCUMENTATION TO LBREINING@PRACTICE-ALT.COM OR FAX 732-383-6840.

MEDICAL NECESSITY GUIDELINES:

The following limitations for coverage apply to all three indications: Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.

 

Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50% or greater improvement through test stimulation. Improvement is measured through voiding diaries.

 

Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.

 

 PLEASE CONTACT BILLING WITH ANY QUESTIONS T# 732-383-4164

 

 

 

UPDATED 12/10/21