Rady Children's Specialists of San Diego Payor Matrix Revised November RCHSD Plan #

Transcription

1 AETNA PPO No No* AETNA PPO MAJOR LEAGUE BASEBALL No No* AETNA PPO OTHER No No* AETNA PPO PRINCIPAL LIFE No No* AETNA PPO SCRIPPS EMPLOYEES No No* BLUE CROSS PPO AFFORDABLE BENEFIT ADMINISTRATORS No No* BLUE CROSS PPO No No* BLUE CROSS PPO ALLIED ADMIN No No* BLUE CROSS PPO CA IRON WORKERS No No* BLUE CROSS PPO CARPENTERS No No* BLUE CROSS PPO COVERED CA 1007 No No* BLUE CROSS PPO DELTA HEALTH No No* BLUE CROSS PPO DIRECTORS GUILD No No* BLUE CROSS PPO EBA&M No No* BLUE CROSS PPO FOOD EMP BENE FUND No No* BLUE CROSS PPO HEALTH SCOPE No No* BLUE CROSS PPO HMSA HAWAII No No* BLUE CROSS PPO INDEMNITY No No* BLUE CROSS PPO LABORERS HEALTH WEL No No* BLUE CROSS PPO MOTION PICTURE No No* BLUE CROSS PPO OPERATING ENGINEERS No No* BLUE CROSS PPO OTHER No No* BLUE CROSS PPO OUT OF STATE No No* BLUE CROSS PPO P5 DELTA HEALTH PLAN No No* BLUE CROSS PPO PINACLE CLAIMS No No* BLUE CROSS PPO PLAN ADMINISTRATORS No No* BLUE CROSS PPO POWER SELECT No No* BLUE CROSS PPO SD ELECTRICAL No No* BLUE CROSS PPO SO CAL DRUG BEN No No* BLUE CROSS PPO TRIBAL HEALTH No No* BLUE CROSS PPO WESTERN GROWERS No No* BLUE SHIELD NATIONAL PPO No No* BLUE SHIELD PPO No No* BLUESHIELD PPO COVERED CA 1009 No No* BLUE SHIELD PPO MOTION PICTURES No No* BLUE SHIELD PPO OTHER No No* BLUE SHIELD PPO OUT OF STATE No No* BLUE SHIELD PPO PIPE TRADE No No* CHAMPUS TRICARE WEST STANDARD *Treated like a PPO No No* CHOICENET PPO No No* CIGNA HEALTHCARE PPO OTHER No No* CIGNA PPO No No*

2 CIGNA PPO MVP HEALTHCARE No No* GREAT WEST LIFE PPO No No* HEALTH NET PPO No No* HEALTH NET PPO OF NORTHEAST No No* HEALTH NET PPO OTHER No No* MEDI-CAL * San Diego is a Mandatory Managed Medi-Cal County* (Double check Eligibility Response for an HMO Plan) Acceptable to Schedule if: 1. Patient has Straight Medi-Cal, no Managed Medi-Cal HMO 2. You have confirmed patient has no other healthcare coverage (HMO, PPO, etc) 3. Appointment is for a NEW Office Visit Consultation No No* MEDICARE No No* MEDICARE PART B No No* NETWORK BY DESIGN PPO No No* PACIFIC FOUNDATION PPO No No* QATAR EMBASSY No No* SAIPAN MEDICAID PROGRAM No No* SAUDI EMBASSY No No* UNITED FOOD & COMM WELFARE PPO No No* UNITED HEALTH CARE PPO No No* UNITED HEALTH CARE PPO OTHER No No* AETNA HMO CPMG No Vision Oral Plastic BC BS PPO FED EMP GOVT No No* BLUE CROSS HMO CAL KIDS CPMG No Vision Oral Plastic

3 BLUE CROSS HMO CPMG No BLUE SHIELD HMO CPMG No CHG MEDI-CAL CHILDREN'S PRIMARY CARE MG No CIGNA HMO CPMG No HEALTH NET HMO CPMG No HEALTH NET MEDI-CAL CPMG No Vision Oral Plastic Vision Oral Plastic Dental Anesthesia Bariatric Services Oral Plastic Reconstructive Services Consult & Procedure for Circumcision PT / OT/ Speech Genetic Testing Vision Oral Plastic Vision Oral Plastic Vision Oral Plastic

4 HEALTH NET POS CPMG quesitons or concerns No MOLINA HEALTHNET CPMG RIVERSIDE No MOLINA MEDI-CAL CHILDREN'S PRIMARY CARE MG No Vision Oral Plastic Dental Anesthesia Bariatric Services Oral Plastic Reconstructive Services Consult & Procedure for Circumcision PT / OT/ Speech Genetic Testing Dental Anesthesia Bariatric Services Oral Plastic Reconstructive Services Consult & Procedure for Circumcision PT / OT/ Speech Genetic Testing SHARP HEALTH PLAN HMO CPMG No Vision Oral Plastic UNITED HEALTHCARE CPMG HMO No GENERIC COMMERCIAL No No* AETNA HMO yes yes AETNA HMO CASSIDY MG yes yes AETNA HMO CFHC ARCH yes yes AETNA HMO GRAYBILL MG yes yes AETNA HMO GREATER TRI CITIES yes yes AETNA HMO HEMET COMM MG yes yes AETNA HMO MERCY PHYSICIAN MG yes yes AETNA HMO MID COUNTY PHYSICIANS yes yes AETNA HMO MONARCH HEALTH yes yes AETNA HMO MULTICULTURAL yes yes AETNA HMO OTHER yes yes AETNA HMO PRIMARY CARE ASSOC MG yes yes AETNA HMO PRIMECARE MG yes yes AETNA HMO SAN DIEGO PHYSICIAN MG yes yes AETNA HMO SCRIPPS CLINIC yes yes AETNA HMO SCRIPPS COASTAL yes yes AETNA HMO SHARP COMMUNITY MG yes yes AETNA HMO SRS yes yes

5 AETNA HMO UCSD MG yes yes AETNA POS/EPO/MC quesitons or concerns Yes for HMO Benefits Yes for HMO Benefits AFFILIATED HEALTH FUNDS yes yes AFFORDABLE BENEFIT yes yes AFTRA HEALTH FUND yes yes ALOHACARE yes yes AMERICAN MEDICAL SECURITY yes yes AMERICAN POSTAL WORKERS yes yes ARIZONA HLTH CONCEPTS(AHCCCS) yes yes ARIZONA MEDICAID yes yes BEECH STREET yes yes BENELECT yes yes BLUE CROSS HMO yes yes BLUE CROSS HMO BEAVER MG yes yes BLUE CROSS HMO CAL KIDS yes yes BLUE CROSS HMO CASSIDY MG yes yes BLUE CROSS HMO CFHC ARCH yes yes BLUE CROSS HMO ENCOMPASS yes yes BLUE CROSS HMO GRAYBILL MG yes yes BLUE CROSS HMO GREATER TRI CITIES yes yes BLUE CROSS HMO HEMET COMM MG yes yes BLUE CROSS HMO MERCY PHYSICIAN MG yes yes BLUE CROSS HMO MID COUNTY PHYSICIANS yes yes BLUE CROSS HMO MONARCH HEALTH yes yes BLUE CROSS HMO MULTICULTURAL yes yes BLUE CROSS HMO OTHER yes yes BLUE CROSS HMO POLINSKY CHILDRENS CENTER yes yes BLUE CROSS HMO PRIMARY CARE ASSOC MG yes yes BLUE CROSS HMO PRIMECARE MG yes yes BLUE CROSS HMO SAN DIEGO PHYSICIANS MG yes yes BLUE CROSS HMO SCRIPPS CLINIC yes yes BLUE CROSS HMO SCRIPPS COASTAL yes yes BLUE CROSS HMO SHARP COMMUNITY MG yes yes BLUE CROSS HMO SRS yes yes BLUE CROSS HMO UCSD yes yes BLUE CROSS MEDI-CAL yes yes BLUE CROSS POS SRS quesitons or concerns Yes for HMO Benefits yes

6 BLUE SHIELD HMO yes yes BLUE SHIELD HMO BEAVER MG yes yes BLUE SHIELD HMO CASSIDY MG yes yes BLUE SHIELD HMO CFHC ARCH yes yes BLUE SHIELD HMO ENCOMPASS MG yes yes BLUE SHIELD HMO GRAYBILL yes yes BLUE SHIELD HMO GREATER TRI CITIES yes yes BLUE SHIELD HMO HEMET COMM MG yes yes BLUE SHIELD HMO IMPERIAL COUNTY PHYSICIAN yes yes BLUE SHIELD HMO MERCY PHYSICIAN MG yes yes BLUE SHIELD HMO MID COUNTY PHYSICIANS yes yes BLUE SHIELD HMO MULTICULTURAL yes yes BLUE SHIELD HMO OTHER yes yes BLUE SHIELD HMO PRIMARY CARE ASSOC MG yes yes BLUE SHIELD HMO PRIMECARE yes yes BLUE SHIELD HMO RIVERSIDE CLINIC yes yes BLUE SHIELD HMO SAN DIEGO PHYSICIANS MG yes yes BLUE SHIELD HMO SCRIPPS CLINIC yes yes BLUE SHIELD HMO SCRIPPS COASTAL yes yes BLUE SHIELD HMO SHARP COMMUNITY MG yes yes BLUE SHIELD HMO SRS yes yes BLUE SHIELD HMO UCSD yes yes CA HEALTH WELLNESS MEDI-CAL yes yes CALIFORNIA FORENSIC MEDICAL GROUP yes yes CALOPTIMA MEDI-CAL yes yes CALOPTIMA OTHER yes yes CARE 1ST MEDI-CAL MANAGED CARE yes yes CARE 1ST MEDI-CAL MULTICULTURAL yes yes CARE 1ST MEDI-CAL VANTAGE yes yes CCS yes yes CCS FOR NEWBORNS yes yes CCS OTHER yes yes CHAMPUS TRICARE FOR LIFE yes yes CHAMPUS TRICARE NORTH yes yes CHAMPUS TRICARE OTHER yes yes CHAMPUS TRICARE PRIME *Treated like an HMO yes yes CHAMPUS TRICARE SOUTH yes yes CHAMPUS TRICARE VETERANS/HANDICAPPED yes yes CHDP yes yes CHG MEDI-CAL NORTH COUNTY HEALTH SERV yes yes CHG MEDI-CAL PEDIATRIC PRIMARY CARE ASSOC MG yes yes CHG MEDI-CAL UCSD yes yes CHG MEDI-CAL VANTAGE yes yes CIGNA HMO yes yes

7 CIGNA HMO CASSIDY MG yes yes CIGNA HMO CFHC ARCH yes yes CIGNA HMO ENCOMPASS MG yes yes CIGNA HMO GRAYBILL MG yes yes CIGNA HMO GREATER TRI CITIES yes yes CIGNA HMO HEMET yes yes CIGNA HMO INTERNATIONAL yes yes CIGNA HMO MID COUNTY PHYSICIANS yes yes CIGNA HMO MULTICULTURAL yes yes CIGNA HMO OPEN ACCESS yes yes CIGNA HMO OTHER yes yes CIGNA HMO PRIMARY CARE ASSOC MG yes yes CIGNA HMO PRIMECARE MG yes yes CIGNA HMO PRIMECARE MG SUN CITY yes yes CIGNA HMO PRIMECARE MG TEM yes yes CIGNA HMO SAN DIEGO PHYSICIANS MG yes yes CIGNA HMO SCRIPPS CLINIC yes yes CIGNA HMO SCRIPPS COASTAL yes yes CIGNA HMO SHARP COMMUNITY MG yes yes CIGNA HMO SRS yes yes CIGNA HMO STAR BRIDGE CHOICES yes yes CIGNA HMO UCSD yes yes COMMUNITY ADMINISTRATORS PPO FIRST HEALTH yes yes COMMUNITY HEALTH GROUP MEDI-CAL yes yes COMMUNITY HEALTH GROUP POLINSKY CHILDRENS CTR yes yes CORESOURCE yes yes CORESOURCE Cigna yes yes CORESOURCE FIRST HEALTH yes yes CORESOURCE PHCS yes yes COUNTY MEDICAL SERVICES yes yes COVENTRY HEALTHCARE yes yes COX FUNDING yes yes CPS DSS FISCAL DIV CSB PYMTS yes yes DELTA HEALTH yes yes DEPARTMENT OF REHAB yes yes EBA&M CORPORATION yes yes EMERGENCY ASSOCIATES yes yes FIRST HEALTH yes yes FIRST HEALTH PLAN HANDLERS yes yes FIRST HEALTH PREFERRED PROVIDER yes yes FIRST HEALTH PRINCIPAL LIFE yes yes FIRST HEALTH SINCLAIR yes yes FIRST HEALTH TEAMSTERS yes yes FIRST HEALTH TRIBAL yes yes GEHA GOVERNMENT EMP HOS yes yes

8 GENETICALLY HANDICAPPED yes yes GREAT WEST LIFE HMO yes yes GREAT WEST LIFE HMO GRAYBILL MG yes yes GREAT WEST LIFE HMO PRIMECARE yes yes GREAT WEST LIFE HMO SAN DIEGO PHYSICIANS MG yes yes GREAT WEST LIFE HMO SRS yes yes GUARDIAN yes yes HAWAII MCAID BC HMSA QUEST yes yes HAWAII MCAID KAISER QUEST yes yes HAWAII MEDICAID yes yes HEALTH COMP HMO POS Yes for HMO Benefits yes quesitons or concerns. Health Comp will support RCHSD referral requirements by specialty. HEALTH NET HMO yes yes HEALTH NET HMO CASSIDY MG yes yes HEALTHNET HMO COVERED CA 1031 yes yes HEALTH NET HMO CFHC ARCH yes yes HEALTH NET HMO DIRECT NETWORK SAN DIEGO yes yes HEALTH NET HMO ENCOMPASS yes yes HEALTH NET HMO GRAYBILL MG yes yes HEALTH NET HMO GREATER TRI CITIES yes yes HEALTH NET HMO HEMET COMMUNITY MG yes yes HEALTH NET HMO MERCY PHYSICIAN MG yes yes HEALTH NET HMO MID COUNTY PHYSICIANS yes yes HEALTH NET HMO MONARCH HEALTHCARE yes yes HEALTH NET HMO MULTICULTURAL yes yes HEALTH NET HMO OTHER yes yes HEALTH NET HMO POLINSKY CHILDRENS CENTER yes yes HEALTH NET HMO PRIMARY CARE ASSOC MG yes yes HEALTH NET HMO PRIMECARE yes yes HEALTH NET HMO SAN DIEGO PHYSICIANS MG yes yes HEALTH NET HMO SCRIPPS CLINIC yes yes HEALTH NET HMO SCRIPPS COASTAL yes yes HEALTH NET HMO SHARP COMMUNITY MG yes yes HEALTH NET HMO SRS yes yes HEALTH NET HMO UCSD yes yes HEALTH NET HMO VANTAGE yes yes HEALTH NET MEDI-CAL yes yes HEALTH NET MEDI-CAL MULTICULTURAL yes yes HEALTH NET MEDI-CAL NORTH COUNTY HEALTH SERVICES yes yes HEALTH NET MEDI-CAL VANTAGE yes yes

9 HEALTH NET POS SRS quesitons or concerns Yes for HMO Benefits Yes for HMO Benefits HEALTH PAYORS ORGANIZATION yes yes HEALTHCOMP SCRIPPS EMPLOYEES yes yes HELLER ASSOCIATES yes yes HMA INC HAWAII yes yes HUMANA yes yes INDIAN HEALTH COUNCIL yes yes INLAND EMPIRE FACULTY MED GRP yes yes INLAND EMPIRE HEMET COMM MG yes yes INLAND EMPIRE LASALLE MED ASSO yes yes INLAND EMPIRE MEDI-CAL HMO yes yes INLAND EMPIRE RIVERSIDE PHYSICIANS yes yes INLAND EMPIRE TOWER HEALTH yes yes INLAND EMPIRE VALLEY VISTA PEDS yes yes INLAND EMPIRE VANTAGE yes yes INTERPLAN yes yes KAISER COVERED CA 1038 yes yes KAISER EPO Yes yes KAISER GENERAL SURGERY/OTHER yes yes KAISER HAWAII yes yes KAISER MEDI-CAL HMO yes yes KAISER MEDICARE ADVANTAGE HMO yes yes KAISER NORTHERN CA yes yes KAISER SAN DIEGO yes yes LAUNDRY & DRY CLEANING WORKERS HEALTH & yes yes LIFESHARING yes yes LOBUE LASER & MEDICAL CENTER yes yes LOS ANGELES FIREMANS RELIEF FUND yes yes MAILHANDLERS BENEFIT PLAN yes yes MEDI-CAL HMO OTHER yes yes MEDI-CAL NEWBORNS no no MEDI-CAL PRESUMPTIVE ELIGIBLE no no MEDI-CAL RESTRICTED no no MEDI-CAL SHARE OF COST no no MEDICARE OTHER yes yes MIDWEST NATIONAL yes yes MOLINA HMO COVERED CA yes yes MOLINA AIM yes yes MOLINA MEDI-CAL yes yes MOLINA MEDI-CAL MULTICULTURAL yes yes MOLINA MEDI-CAL OTHER yes yes

10 MOLINA MEDI-CAL RIVERSIDE yes yes MOLINA MEDI-CAL VANTAGE yes yes MOLINA OUT OF STATE yes yes MOLINA POLINSKY CHILDREN'S CTR yes yes MOUNTAIN STATES CCN yes yes MULTIPLAN yes yes MULTIPLAN PRINCIPAL LIFE yes yes MUSCULAR DYSTROPHY ASSOCIATION yes yes MUTUAL OF OMAHA NEBRASKA yes yes NATIONAL AMERICAN LETTER CARRIER yes yes NATIONAL MARROW DONOR PROGRAM yes yes NATIONAL PREFERRED PROVIDER NETWORK yes yes NATIONWIDE HEALTH PLAN yes yes NEVADA MEDICAID yes yes OHANA HEALTH PLAN yes yes OPERATING ENGINEERS LOCAL yes yes OUT OF STATE MEDICAID yes yes PACIFIC FOUNDATION EPO yes yes PIA yes yes PRIVATE HEALTH CARE SYSTEMS yes yes PUBLIC SECTOR CLAIMS yes yes QUEST EXPANDED ACCESS yes yes RETAIL CLERKS LOCAL yes yes SAN DIEGO COUNTY SCHOOL BENEFITS-FRINGE yes yes SAN DIEGO HOTEL & RESTAURANT yes yes SHARP HEALTH PLAN HMO yes yes SHARP HEALTH PLAN HMO CFHC ARCH yes yes SHARP HEALTH PLAN HMO GRAYBILL yes yes SHARP HEALTH PLAN HMO GREATER TRI CITIES yes yes SHARP HEALTH PLAN HMO PCAMG yes yes SHARP HEALTH PLAN HMO SCRIPPS COASTAL yes yes SHARP HEALTH PLAN HMO SHARP COMMUNITY MG yes yes SHARP HEALTH PLAN HMO SRS yes yes SHAW MEDICAL yes yes SOUTHERN INDIAN HEALTH ALPINE yes yes SOUTHWEST ADMINISTRATORS yes yes UHC ALLIANCE HMO SCLINIC yes yes UHC ALLIANCE HMO SCOASTAL yes yes UHC SCRIPPS RESEARCH INSTITUTE yes yes UNICARE OTHER yes yes UNICARE PRUDENT BUYER yes yes UNITED AGRICULTURE yes yes UNITED EMIRATES EMBASSY yes yes UNITED HEALTH CARE OXFORD yes yes UNITED HEALTHCARE HMO yes yes

11 UNITED HEALTHCARE HMO CASSIDY yes yes UNITED HEALTHCARE HMO CFHC ARCH yes yes UNITED HEALTHCARE HMO ENCOMPASS MG yes yes UNITED HEALTHCARE HMO GRAYBILL MG yes yes UNITED HEALTHCARE HMO GREATER TRI CITIES yes yes UNITED HEALTHCARE HMO HEMET COMMUNITY yes yes UNITED HEALTHCARE HMO IMPERIAL VALLEY yes yes UNITED HEALTHCARE HMO MERCY PHYSICIAN MG yes yes UNITED HEALTHCARE HMO MID COUNTY PHYSICIANS yes yes UNITED HEALTHCARE HMO MONARCH HEALTHCARE yes yes UNITED HEALTHCARE HMO MULTICULTURAL yes yes UNITED HEALTHCARE HMO OTHER yes yes UNITED HEALTHCARE HMO PALOMAR POMERADO yes yes UNITED HEALTHCARE HMO PRIMARY CARE ASSOC MG yes yes UNITED HEALTHCARE HMO PRIMECARE yes yes UNITED HEALTHCARE HMO RANCHO FAMILY MG yes yes UNITED HEALTHCARE HMO SAN DIEGO PHYSICIANS MG yes yes UNITED HEALTHCARE HMO SCRIPPS CLINIC yes yes UNITED HEALTHCARE HMO SCRIPPS COASTAL yes yes UNITED HEALTHCARE HMO SECURE HORIZONS yes yes UNITED HEALTHCARE HMO SHARP COMMUNITY MG yes yes UNITED HEALTHCARE HMO SHARP COMMUNITY MG NORTH INLA yes yes UNITED HEALTHCARE HMO SRS yes yes UNITED HEALTHCARE HMO UCSD yes yes UNITED HEALTHCARE HMO UNION PACIFIC yes yes UNITED HEALTHCARE POS quesitons or concerns Yes for HMO Benefits Yes for HMO Benefits UNITED HEALTHCARE UNITED MEDICAL RESOURCES yes yes WAUSAU BENEFITS yes yes WESTERN GROWERS yes yes YOUNG LIFE BENEFITS yes yes * Prior authorization may be required for diagnostic testing. Please contact your health plan for benefit information, authorization requirements and out of pocket responsibility.