• Important Telephone Numbers
  • Main T. 610.740.9500
  • Scheduling T. 610.740.9500 (Option 3)F. 610.740.0288
  • Clinical Questions T. 610.740.9500 (Option 6)F. 610.740.0288
  • Billing T. 610.740.0400F. 610.437.6263
  • Physician Liaison T. 610.740.9733

Insurance & Pre-certification Guide

Getting pre-certification requirements for participating health plans has never been easier. Find the information you need right here, along with links to individual provider's websites.

  • Billing T: 610.740.0400
  • Scheduling T: 610.740.9500 (Option 3)
  • Tax ID: # 23-2461422
  • NPI: # 1487608634

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Generally secondary to Medicare. 23-2461422 AARP Health 800.227.7789

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Prior notification (pre-certification) through United Healthcare 23-2461422 United Healthcare Clinical Request Line
866.889.8054

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification through PA Dept. of Public Welfare, Radiology Prior Authorization Line. 0011127180009 Outpatient Radiology Prior Authorization Services
Pre-certification through NIA: CPT code specific. 800.424.4213

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Medicare Advantage plan through Health America. 23-2461422 Health America 800.788.8445

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through PA Dept of Public Welfare or Aetna Better Health. 0011127180009 Aetna Better Health 866.638.1232
Pre-certification through NIA: CPT code specific.

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification generally through Med Solutions: CPT code specific. 49954 Aetna Dedicated Provider Service Center
800.624.0756
Med Solutions 888.693.3211

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Medicare Advantage plan. 23-2461422 American Progressive Insurance Service Center
800.645.4116

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet or plan. Benefits page indicates if pre-certification required. 23-2461422 AmeriHealth Administrators 800.480.5035
Pre-certification through Patient Care Management Department. Patient Care Management Department 800.952.3404

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Administered through Independence Blue Cross. Eligibility and benefits verified through NaviNet. 0079277000 AIM Specialty Health
866.745.1791
Pre-certification through AIM.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibilty and benefits verified through NaviNet. Pre-certification through Med Solutions: CPT code specific. 47983 Med Solutions 800.572.1981

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Contact Blue Card or phone number listed on insurance card for pre-certification requirements. 100388 Blue Card Eligibility 800.676.2583

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification through Med Solutions. 23-2461422 Med Solutions 888.693.3211

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Scheduling and pre-certification through One Call Medical. 23-2461422 One Call Medical
973.257.1000

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Contact Blue Card for eligibility and benefits for each state. BS of Nebraska requires pre-certification for breast MRI. 100388 Blue Card Eligibility 800.676.2583

PRE-CERTIFICATION REQUIRED:

  • No, except breast
COMMENTS PROVIDER NUMBER PHONE NUMBER
Only breast MRI requires pre-certification: approval based on medical policy. 100388 Blue Card Eligibility 800.676.2583

PRE-CERTIFICATION REQUIRED:

  • No, except breast
COMMENTS PROVIDER NUMBER PHONE NUMBER
Only breast MRI requires pre-certification: approval based on medical policy. 100388 BC/BS of Illinois Provider Services
888.979.4516
Required documentation must be faxed to plan to obtain pre-certification. Fax: 217.862.7282

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification through Med Solutions. 100388 Med Solutions 888.693.3211

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No, except breast
COMMENTS PROVIDER NUMBER PHONE NUMBER
Only breast MRI requires pre-certification regardless of plan. Approval based on clinical guidelines/considerations. Pre-certification is through Capital Blue Cross. 03219800 Clinical Management Department of Capital Blue Cross
800.471.2242
All MRA's are approved based on medical necessity. Check policy guideline on Capital website.
Do not order MRA head or neck with MRI brain unless a previous exam showed an abnormality or the patient has acute onset cerebral ischemia and the course of therapy will be changed by the results.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through PA Teamsters. 23-2461422 Central Pennsylvania Teamsters
800.422.8330

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Plan for Lehigh Valley Health Network employees: administered through Spectrum Administrators. 23-2461422 Spectrum Administrators 610.969.0410

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through Cigna. All PHS+ patients require pre-certification through Med Solutions: CPT code specific. 23-2461422 Med Solutions 888.693.3211
PHS patients require registration number instead of pre-certification to verify plan has been notified.
Breast MRI approved based on clinical guidelines/considerations.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Lehigh Magnetic Imaging Center is out of network provider: Patient is responsible for bill. 23-2461422 Emblem Health
800.358.5500
Eligibility and benefits through Emblem Health website.
Insurance billed if Emblem Health is secondary to Medicare.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. 100388 AIM Specialty Health
877.430.2288
Pre-certification through AIM.
ICD-9 and CPT codes needed for pre-certification.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Medicare Advantage Plan administered through United Healthcare, third party administrator (TPA). Most plans require prior notification (pre-certification). 23-2461422 United Healthcare for Evercare
888.866.8298

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Workers' compensation program through Department of Labor. 23-2461422 Department of Labor 800.347.3755
Diagnosis must be related to black lung disease to bill insurance.

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Plan for Federal employees. ID number starts with an R. 100388 Blue Card Eligibility 800.676.2583

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification, eligibility and benefits must be obtained through the third party administrators (TPA). 23-2461422 TPA (provided on back of ID card).

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
CPT code needed for pre-certification. 079746 First Priority Health 800.822.8753

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes, except self-funded plans
COMMENTS PROVIDER NUMBER PHONE NUMBER
Plan administered through BC/BS of Northeastern PA and billed through Highmark Blue Shield. 100388 Blue Card Eligibility 800.676.2583
Eligibility and benefits verified through Blue Card. NIA Outpatient Radiology Authorization Service Traditional
800.638.0505
Pre-certification through NIA: CPT code specific. PPO
866.262.5623

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Medicare Advantage plan administered through Highmark Blue Shield. Eligibility and benefits verified through NaviNet. 100388 NIA Highmark Outpatient Radiology Authorization Service
888.642.4814
Pre-certification required except for alpha prefix HKR.
Pre-certification through NIA.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
HMO Access Plan. Pre-certification through NIA. 7100388 NIA Gateway Outpatient Radiology Authorization Service
888.879.5922

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
HMO Medicare Replacement Plan Pre-certification through NIA. 7100388 NIA Gateway Outpatient Radiology Authorization Service
888.879.5922

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification through NIA. 23-2461422 NIA Outpatient Radiology Authorization Service
866.305.9729

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Plan administered through United Healthcare, third party administrator (TPA). 23-2461422 Golden Rule Client Services
800.657.8205
Pre-certification through Golden Rule.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Some plans administered through Cigna: refer to ID card. New cards indicate GWH-Cigna. 23-2461422 Med Solutions 888.693.3211
Pre-certification through Med Solutions.

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Contact Authorization Department at HealthAmerica to determine if pre-certification through HealthAmerica or NIA. 23-2461422 HealthAmerica Authorization Department 800.755.1135
Breast MRI approved based on clinical guidelines/considerations. NIA HealthAmerica Outpatient Radiology Authorization Service 866.326.6303

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. Pre-certification through NIA. Breast MRI approved based on clinical guidelines/considerations. 100388 NIA Highmark Outpatient Radiology Authorization Service
888.642.4814

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. 00797277000 Horizon BC/BS of New Jersey
800.355.2583
Breast MRI approved based on clinical guidelines/considerations.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through Humana. 23-2461422 Humana
877.511.5000
Pre-certification through Humana Radiology Services. Humana Radiology Services
866.825.1550

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet or Independence Administrators. 0079277000 Independence Administrators 888.356.7899
Contact Patient Care Management Department to determine pre-certification requirements. Patient Care Management Department of AmeriHealth Administrators 888.234.2393

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. Pre-certification through AIM. 0079277000 AIM Specialty Health
866.745.1791
Breast MRI approved based on diagnostic imaging management program guidelines.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. Pre-certification through NIA. 03219800 NIA Outpatient Radiology Authorization Service
888.203.1423
Pre-certification not required if KHPC is secondary payer.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. 0079277000 AIM Specialty Health
866.745.1791
Pre-certification through AIM. Breast MRI approved based on diagnostic imaging management program guidelines.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. Pre-certification through Med Solutions. Breast MRI approved based on clinical guidelines/considerations. 47983 Med Solutions
800.572.1981

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through NaviNet. Pre-certification through NIA. Plan with alpha prefix YWW does not require pre-certification. 03219800 NIA Outpatient Radiology Authorization Service
888.203.1423

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through Mega Life website. 23-2461422 Mega Life Health Market Insurance Center
888.757.0703

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Valley Preferred product for Knoll Industries employees. 23-2461422 Medical Management 800.542.6355
Pre-certification through Medical Management.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through Novitas ARS (automated response system). 100388 Novitas Solutions
877.235.8073
MRA and Breast MRI's limited to specific ICD-9 codes verified through Novitas website under Local Coverage Determination Page.
Breast MRI approved based on clinical guidelines/considerations.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Scheduling and pre-certification through One Call Medical. 23-2461422 One Call Medical 973.257.1000

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification through Oxford Care Core. A1231025 Oxford Care Core
877.773.2884

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
PPO plan of Independence Blue Cross. Eligibility and benefits verified through NaviNet. 0079277000 AIM Specialty Health
866.745.1791
Pre-certification through AIM.
Breast MRI approved based on diagnostic imaging management program guidelines.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Follows Novitas Solutions' guidelines. CF3061 Railroad Medicare 877.288.7600

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Medicare Advantage Plan administered through United Healthcare, third party administrator (TPA). Most plans require prior notification (pre-certification). 23-2461422 United Healthcare Clinical Request Line
866.889.8054

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Lehigh Magnetic Imaging Center does not participate but study can be performed if pre-certified. 23-2461422 HealthNet Federal Services Tricare Customer Service 877.874.2273

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • No
COMMENTS PROVIDER NUMBER PHONE NUMBER
Benefits and eligibility verified through Tricare. 23-2461422 HealthNet Federal Services Tricare Customer Service 877.874.2273

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Most plans require prior notification (pre-certification): CPT code specific. United Healthcare as secondary does not need a prior notification. Breast MRI approved based on Medical Policy. 23-2461422 United Healthcare Clinical Request Line 866.889.8054 New Notification #1 Existing Notification #2

PRE-CERTIFICATION REQUIRED:

  • Yes
COMMENTS PROVIDER NUMBER PHONE NUMBER
Eligibility and benefits verified through Unison. 126102 Unison
800.600.9007
Pre-certification needed unless the PCP is a Gold Star member.

INSURANCE CARRIER:

PRE-CERTIFICATION REQUIRED:

  • Depends on plan
COMMENTS PROVIDER NUMBER PHONE NUMBER
Pre-certification, eligibility and benefits must be obtained through the TPA (third party administrator). 23-2461422 Call TPA (name and number on the back of ID card).