CA-NV INSURANCE REFERENCE GUIDE

	Auth- Reference	E0601-CPAP	E0470-BIPAP	E0471-ASV-ST-AVAPS	E0562-HEATED HUMIDIFIER	E1390- OXYGEN CONCENTRATOR- NIGHT TIME	E1392- OXYGEN-POC DAY TIME	E0466/E0465- VENTILATOR- NIV-INVASIVE	E0483- VEST	E0482- COUGHASSIST	E0570- NEBULIZER	A CODES- PAP SUPPPLIES	Auth Request- P= Portal, F= Fax, B= Both, N/A= No	Comments
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1	Revised Date 1-7-21
2	Commercial PPO-HMO
3	Aetna	No	No	No	No	No	No					No	N/A	Not auth for Aetna PPO
4	Aetna HMO	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes		Authorization thru Managed care Medical Group
5	Aetna MC Advantage
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7	Anthem Blue Cross	Yes	Yes	Yes	Yes							No	B	1. E0601, E0470, E0471, E0562- Always Rental 2.Check to see is AIMS program 3. Check if HMO- Authorization from Managed Care 4. Operating Engineers Policy ID starts with "OE" 5. DELTA - Policy ID ends with "D"
8	Anthem BC- AIMS	Yes	Yes	Yes	Yes	N/A	N/A	N/A	N/A	N/A	N/A	Yes	P	Compliance Report is Needed. AIMS is only for Sleep Therapy
9	Anthem BC HMO	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes		Authorization thru Managed care Medical Group
10	Anthen BC/BS of NV	No	No	No	No							No	N/A
11	Anthem BC MC Advantage													If Anthem MC Advantage is under Aims then need auth if Not then No Auth needed
12	Anthem BC Medi-cal	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
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14	Blue Shield PPO/IFP PLAN	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	B	Both PPO AND IFP BEFORE ARE AUTH NEEDED AT SET UP BUT SEEMS TODAY BS UPDATE THEY START TO NOT REQUIRE AUTH FOR INITIAL SET UP. BEFORE Anything starts with "H" in AUTH number means no auth needed for supplies and its PPO. If plan is PPO then no auth needed for supplies; DED is applicable to DME if its IFP then auth needed; DED is N/A to DME
15	Blue Shield HMO	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
16	Blue Shield IFBP	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
17	Blue Shield Federal	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes		ID# Starts with R, Auth= Yes
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19	Care Centrix- SMS	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
20	Care Centrix- FFS	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
21
22	Cigna- Use Care Centrix Ref	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
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24	CareMore- MC Advantage	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	B
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26	United Health Care	No	No	No	No	No	No	No	No	No	No	No	N/A
27	United Health Care- MC Advantage	No	No	No	No	No	No	No	No	No	No	No	N/A
28	United Health Care- HMO Risk	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	B	We're NOT CONTRACTED
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30	MediCare FFS	No	No	No	No	No	No	No	No	No	No	No	N/A
31
32
33	Tricare	Yes	Yes	Yes	Yes							Yes
34	Triwest	Yes	Yes	Yes	Yes	Yes	Yes					Yes
35
36	UMR	No	No	No	No	No	No	No	No	No	No	No	N/A
37	Medicare- MC Advantage Plans
38	SMHP- Care Advantage
39	SCFHP-Duals
40	CareMore
41	Seoul Medical Group
42
43
44
45	Medi-cal- Advantage Plans
46	Medi-Cal	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	B
47	Central CA Alliance	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No	No	B
48	Santa Clara Family Healthplan	Yes	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes	F	1. Predetermination for oxygen is no longer required since July 2020.but per rep advised,its better to send a request as it varies depends on pt's health plan. 2. ID Starts "3" No Letter= Medi-Connect 3. ID Starts "9" and Ends With Letter= Medi-cal
49	Health Plan of San Mateo	No	No	No	No	No	No	No	No	No	No	No	P
50	Partnership	No	No	No	No	No	No	No	No	No	No	No	N/A	???
51	Xerox	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	B
52
53
54	HMO Managed Care Groups
55	Palo Alto HMO	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
56	Dignity HMO	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	P
57	Physicians Medical Group of San Jose	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	F
58	Health Plan of San Mateo	No	No	No	No	No	No	No	No	No	No	No	P
59	Infinity	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
60	SCCIPA	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes		Authorization must be submitted by the ordering doctor, PS can not submit authorization to SCCIPA
61	Hills Physician	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
62	Affinity	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
63	Aspire Health Plan	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
64	Brown & Toland	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
65	CCHP- Chinese Community	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
66	Meritage Medical Network	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
67	San Jose Medical Group	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
68	Sante' Health Systems	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
69	Santa Clara Family Healthplan	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
70	Seoul Medical Group	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
71	Sutter Health	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
72	UC Davis	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
73	UHC Duals- Alameda County	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
74
75
76
77
78	Nevada Health Plans
79	Meritian Health	No	No	No	No	No	No	No	No	No	No	No	N/A
80	Hometown	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	B
81	HealthScope Benefits	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	B
82
83
84	Teachers Health Trust	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes		If Auth needed then quantity should be 1 month; If no auth needed then 3 months supplies
85	Western Growers	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No
86
87	Multiplan	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes			MULTIPLAN: +1 800-678-7427 HEALTH PLAN SHOULD BE ON THE PT CARD -PPO WEBSITE: MULTIPLAN.COM
88														AUTH: PAR OVER $500.00FAX: PHONE AUTH DEPT: MEDICAL REHAB CONSULTANT 1800-827-5058 CLAIMS ADRRESS: PO BOX 5433 SPOKANE WA 99205
89	First Choice	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes			FIRST CHOICE: +1 800-231-6935 -PPO WEBSITE: FCHN.COM POLICY ID: STARTS WITH 807