Referidos de Proveedores de Salud y Solicitud de Autorización de Información

Referidos versus Autorización Previa

El referido es el proceso de enviar un paciente a donde otro profesional (por ejemplo, a un especialista) para una consulta o para un servicio de atención de salud, que la fuente de referencia considera necesario, pero que no está preparada o calificada para proveer. Su médico de atención primaria lo remitirá donde un especialista participante o a un proveedor de servicio de atención de salud, si él o ella no puede proporcionar personalmente la atención que usted necesita. Muchos referidos no necesitan un número de autorización.

La autorización, también conocida como pre-certificación, es un proceso de revisión de ciertos servicios médicos, quirúrgicos o de salud del comportamiento, para estar seguros de las necesidades médicas y de la atención apropiada antes de que se proporcionen los servicios. La revisión también incluye una determinación sobre si el servicio que se solicita está cubierto bajo su plan de beneficios. Las autorizaciones son requeridas únicamente para ciertos servicios. Su médico someterá la solicitud de autorización/pre-certificación electrónicamente, por teléfono o escribiendo un fax o un correo electrónico.

¿Qué hacer después?

Si el estudio que su hijo va a recibir requiere de autorización, por favor póngase en contacto con el proveedor de salud que ordena el estudio para que le proporcione los detalles de la cita (fecha/hora de la cita) para que empiece el proceso de autorización; a menos que su plan de seguro exija la autorización del médico primario, en cuyo caso, por favor póngase en contacto con su médico primario para solicitar una autorización.

Por favor a continuación haga clic en el plan de salud deseado, para verificar si se requiere una autorización previa a través de su plan de salud para los servicios de diagnóstico ambulatorio más comunes. Cualquier servicio que no esté listado en el enlace, por favor póngase en contacto con la Unidad de Autorización llamando al 786-624-3022 para más información.

*Por favor tenga en cuenta que la información que se indica es general y que cada plan de grupo puede tener requisitos distintos que no encuadran dentro de estos lineamientos. Para enterarse sobre requisitos específicos, por favor contacte directamente su plan de salud.

Authorization Policies for Aetna Better Health, Inc

Health Provider Website: https://www.aetnabetterhealth.com/
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: YES
Polysonograms: YES**
Ultrasounds: YES
Physical Therapy: No Benefits
Occupational Therapy: No Benefits
Audio Evaluation: YES
Speech Evaluation: No Benefits
Feeding and Swallowing Evaluation: No Benefits

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-693-3211 to obtain authorization.
**Aetna members must utilize the United Health Systems Sleeps Centers. Authorizations are only valid for NCH once an attempt was made at United Health Systems.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Aetna U.S. Healthcare, Inc

Health Provider Website: https://www.aetna.com/
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-693-3211 to obtain authorization.
** Authorizations for Polysomnograms are issued by Evicore. Please contact 1-888-693-3211 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.

Authorization Policies for Amerigroup Florida, Inc

Health Provider Website: https://www.amerigroup.com/
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES
Ultrasounds: NO
Physical Therapy: NO**
Occupational Therapy: NO**
Audio Evaluation: NO
Speech Evaluation: NO**
Feeding and Swallowing Evaluation: NO**

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by American Imagining Management (AIM). Please contact 1-800-714-0040 to obtain authorization.
**Please note Although Amerigroup does not require pre-certification for rehabilitate evaluations, based on your child’s diagnosis your child may or may not be covered to receive services in our facility.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for AvMed Health Plan

Health Provider Website: https://www.avmed.org/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-663-8387 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Best Doctors, Inc.

Health Provider Website: http://www.bestdoctors.com/
Accepted Health Plans: International

Does the diagnostic service require prior authorization?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.

Authorization Policies for Better Health

Health Provider Website: http://www.betterhealthflorida.com/
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES

*Please note, all studies that are performed at our main campus, or any of our off-site centers, require authorization from this health plan.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
Blue options

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: PPO Federal Exchange

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-326-6302 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-855-243-3326 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
Federal plan

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: PPO

Does the diagnostic service require prior authorization?

MRI: NO
CT Scans: NO
PET: NO
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
Network Blue

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: PPO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-326-6302 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-855-243-3326 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
of Florida Health Options, Inc.

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: HMO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-326-6302 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross Blue Shield
Out of State

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: CALL*
CT Scans: CALL*
PET: CALL*
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL

*Authorizations for high-end imaging (MRI, CT, PET Scans) are usually handled by a third party. Please contact the health plan directly for specifics regarding authorization submission.
Out of state policies differ in authorization requirements dependent on the state. For all authorization requirements done in an outpatient hospital setting, please contact the health plan for details.

Authorization Policies for Cigna Healthcare

Health Provider Website: http://www.cigna.com/
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-693-3297 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-877-877-9899 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.

Authorization Policies for CMS Network

Health Provider Website: http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/eligibility-and-services/index.html
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics or Physician Prescription
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form or prescription (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Coventry HMO & PPO

Health Provider Website: http://coventryhealthcare.com/
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO**
Polysonograms: YES
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: YES
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-800-642-7821 to obtain authorization.
**Authorization requirements are based on procedure code. Please contact the Authorization Unit for verification on whether or not your specific x-ray requires authorization


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.

Authorization Policies for Health Ease, Inc. of Florida

Health Provider Website: https://www.wellcare.com/Florida
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO***
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: YES
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-333-2641 to obtain authorization.
**Authorizations for polysonograms are issued by Evicore. Please contact 1-888-333-8641 to obtain authorization.
***Doppler ultrasounds do require authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Humana HMO

Health Provider Website: https://www.humana.com/
Accepted Health Plans: HMO PPO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Health Help. Please contact 1-866-825-1550 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Humana Medicaid

Health Provider Website: https://www.humana.com/
Accepted Health Plans: HMO PPO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: No Benefits
Occupational Therapy: No Benefits
Audio Evaluation: YES
Speech Evaluation: No Benefits
Feeding and Swallowing Evaluation: No Benefits




Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Humana PPO

Health Provider Website: https://www.humana.com/
Accepted Health Plans: HMO PPO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Health Help. Please contact 1-866-825-1550 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Medicaid of Florida

Health Provider Website: http://www.myflfamilies.com/service-programs/access-florida-food-medical-assistance-cash/medicaid
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO*
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Only pelvic ultrasounds require authorization. Please submit authorization through the eQSuite portal. http://fl.eqhs.org/


Lab Information

Preferred Independent Lab: LabCorp, Quest or Physician Prescription
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form or prescription (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Molina Healthcare of Florida, Inc.

Health Provider Website: http://www.molinahealthcare.com/en-us/Pages/home.aspx?CookieCheck=true
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: YES*
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Patients 5 years old or younger do not require authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Multiplan

Health Provider Website: https://www.multiplan.com
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL



Authorization Policies for Neighborhood Health Partnership, Inc. [NHP]

Health Provider Website: https://www.mynhp.com/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-866-242-9546 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Preferred Medical Plan

Health Provider Website: http://www.pmphmo.com/
Accepted Health Plans: HMO

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: No Benefits
Occupational Therapy: No Benefits
Audio Evaluation: YES
Speech Evaluation: No Benefits
Feeding and Swallowing Evaluation: No Benefits



Authorization Policies for Prestige Health Choice, LLC

Health Provider Website: https://www.prestigehealthchoice.com/
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Simply Healthcare Plans, Inc.

Health Provider Website: http://www.simplyhealthcareplans.com/
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Staywell

Health Provider Website: https://www.wellcare.com/Florida
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO***
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: YES
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-333-2641 to obtain authorization.
**Authorizations for polysonograms are issued by Evicore. Please contact 1-888-333-8641 to obtain authorization.
***Doppler ultrasounds do require authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Sunshine State Health Plan

Health Provider Website: https://www.sunshinehealth.com/
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by NIA Please contact 1-866-214-2569 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Tricare

Health Provider Website: https://www.mytricare.com/mtc/
Accepted Health Plans:

Does the diagnostic service require prior authorization?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL




Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for UMR

Health Provider Website: https://www.umr.com/tpa-ap-web/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: CALL
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO



Authorization Policies for United HMO-PPO

Health Provider Website: https://www.myuhc.com/member/prewelcome.do
Accepted Health Plans: HMO PPO Medicaid Healthy Kids International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by United Healthcare. Please contact 1-866-889-8054 to obtain authorization.
**Patients 5 years old or younger do not require authorization.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.

Authorization Policies for United Medicaid

Health Provider Website: https://www.myuhc.com/member/prewelcome.do
Accepted Health Plans: HMO PPO Federal Exchange Medicaid Healthy Kids International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by United Healthcare. Please contact 1-866-889-8054 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.

Authorization Policies for Virgin Islands Medicaid Program

Health Provider Website: http://www.dhs.gov.vi/financial_programs/medical_assistance.html
Accepted Health Plans: Medicaid International

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@mch.com or by calling 305-662-8281.