● WellCare: Medicare & Medicaid to NPI 1407258692 Echocardiogram (93306).

● Horizon Blue Prefix: “NJN” Echocardiogram (93306), “YFW” Carotid Doppler (93880, 93931)

● Aetna Medicare HMO: Insurance starting with “ME” to NPI 1407258692

● Aetna Medicare HMO Prime: Referral to NPI 1407258692

● CLOVER PRE-AUTHORIZATION NEEDED FOR:

● TCD (93886) 1 UNIT

● 1. SELECT “NO FOR INPATIENT ER NOTICE OF ADMISSION”

● 2. SLELECT “OUTPATIENT FOR TYPE OF SERVICE”

● 3. ENTER THE PLACE OF SERVICE-11 (OFFICE) AND DATE OF SERVICE

● 4. ENTER SERVICE CODE AND START YOUR REQUEST

● 5. ENTER THE PATIENT’S INFORMATION ALONG WITH THE PRIMARY DIAGNOSIS CODE (ICD-10 I65.23,R55)

● 6. ENTER THE REQUESTING PROVIDER/FACILITYOFFICE INFORMATION WITH NPI, ADDRESS, CONTACT INFORMATION

● 7. ENTER THE SERVICING PROVIDER/FACILITY INFORMATION:NPI 1407258692. H&D SONOGRAPHY,60 BALDWIN STE 101A, PARSIPPANY, NJ 07054. PERSON OF CONTACT: BILLING DEPT.

● THIS REQUEST IS NOT FOR AN EXPEDITED ORGANIZATION DETERMINATION, AT THE END OF REQUESTING PRE-AUTH PLEASE ATTACH MEDICAL RECORDS AND SUBMIT YOUR REQUEST.ONCE YOU HAVE RECEIVED YOUR APPROVED AUTHORIZATION NUMBER, PLEASE FAX IT TO 973-866-0353 WITH THE PATIENTS PAPERWORK READY TO BE SCHEDULED.

● EVICORE PRE-AUTHORIZATION NEEDED FOR: HORIZON BC BS AND CLOVER

● ECHO (93306) 1 UNIT ONLY

● 1. SELECT “REQUEST AN AUTH “

● 2. SELECT “RADIOLOGY/CARDIOLOGY”

● 3. SELECT “REQUESTING PROVIDER”

● 4. SELECT THE PATIENTS HEALTH PLAN AND ADDRESS

● 5. ENTER PROVIDERS CONTACT INFO

● 6. HAS PROCEDURE BEEN PERFOMED- SELECT “NO”

● 7. ENTER THE PATIENTS ELIGIBILITY: ID#, DATE OF BIRTH, LAST NAME ONLY…(IF PATIENT INFO IS NOT LOCATED YOU MUST CONTACT EVICOREAT 1-877-773-6964)

● 8. SELECT THE CORRECT PATIENT IN SEARCH RESULTS THEN SELECT CONTINUE

● 9. SELECT PRIMARY PROCEDURE BY CPT CODE IN DROP DOWN BOX (SELECT 93306)-ECHOCARDIOGRAM

● 10. ENETRDIAGNOSIS CODE( R01.1,R07.9) THEN SELECT CONTINUE

● 11. WILL PROCEDURE BE PERFORMED IN OFFICE-SELECT “YES” THEN CONTINUE

● 12. LOOKUP AND SELECT THE SITE(OFFICE) FOR THE SERVICE, CONTINUE

● 13. IS CASE ROUTINE/STANDARD- SELECT “YES”

● 14. WILL THERE BE ANY ADDITIONAL PROCEDURES-SELECT “NO”

● 15. SELECT THE ACKNOWLEDGEMENT BOX AND SUBMIT CASE

● ONCE YOU HAVE RECEIVED YOUR APPROVED AUTHORIZATION NUMBER, PLEASE FAX IT TO 973-866-0353 WITH THE PATIENT’S PAPERWORK READY TO BE SCHEDULED.