Americhoice of PA Hospital

Insurance Name	Hospital Service	Referral Form Required	Pre-Certification Phone Reference	Initiating Provider
Americhoice of Pennsylvania Americhoice Medicare	Inpatient Acute Care – Elective Non-Elective Extended Acute	Yes No No	Yes Yes Yes	Admitting Physician
Billing Address:	Skilled Nursing Facility	No	Yes	Admitting Physician
Information Network Corp	Outpatient
PO Box 7630	Emergency Room Visits	No	No
Phoenix, AZ 85011-7630	Same Day Surgery	Yes	Yes	PCP/Specialist
	Diagnostic Radiology	Yes	No	PCP
Eligibility 800-345-3627	CT Scan	Yes	No	PCP
	Stress Test	Yes	No	PCP
Pre-Certification 215-473-0938	Nuclear Stress Test	Yes	No	PCP
	Echo	Yes	No	PCP
Provider Services 800-345-3627	Ultrasound	Yes	No	PCP
	Chemotherapy	Yes	Yes	PCP
	Laboratory
	Capitated with Quest	Yes – Quest Lab Form	No
	STAT testing at Hospital	Yes – Write stat on form	No
	Pre-Admission Testing	Yes – See note #1		PCP/Specialist
Referral is good for 30 days	Cardiology Department	Yes	No	PCP
Number of visits on referral	Physical Therapy	Yes	No	PCP
	Speech Therapy	Yes	No	PCP
Contact Person:	Occupational Therapy	Yes	No	PCP
Angel Pagan	Pulmonary/Respiratory	Yes	No	PCP
215-832-4643	Gastroenterology	Yes	No	PCP
	Infusion	Yes	No	PCP

Inpatient