Keystone Health Plan East Hospital

Insurance Name	Hospital Service	Referral Form Required	Pre-Certification Phone Reference	Initiating Provider
Keystone Health Plan East Keystone 65	Inpatient Acute Care – Elective Non-Elective Extended Acute	No No No	Yes Yes Yes	Admitting Physician
Billing Address:	Skilled Nursing Facility	No	Yes	Admitting Physician
	Outpatient
PO Box 898815	Emergency Room Visits	No	No – call within 24 hours after service
Camp Hill, Pa. 17089	Same Day Surgery	Yes	Yes	PCP/Specialist
	Diagnostic Radiology	Yes	No	PCP – Must be Capitated
Eligibility 800-227-3116	CT Scan	Yes	No	PCP – Must be Capitated
	Stress Test	Episode	One Referral	Cardiologist
Pre-Certification 800-227-3116	Nuclear Stress Test	Of	For a 90 day	Cardiologist
	Echo	Care	Period	Cardiologist
Provider Services 800-821-9412	Ultrasound	Yes	Yes	PCP – Must be Capitated
	Chemotherapy	Yes	Yes	PCP
	Laboratory
	Capitated with SmithKline	Yes – SmithKline Form	No
	STAT testing at Hospital	Yes – Write stat on form	Yes
	Pre-Admission Testing	Yes – See note #1		PCP/Specialist
Referral is good for 90 days	Cardiology Department	Episode of Care	No	Cardiologist
Number of visits on referral	Physical Therapy	Yes	Yes	PCP – Must be Capitated
	Speech Therapy	Yes	Yes	PCP
Contact Person:	Occupational Therapy	Yes	Yes	PCP – Must be Capitated
Patricia Wynn	Pulmonary/Respiratory	Yes	Yes	PCP/Specialist
610-225-6810	Gastroenterology	Episode of Care	No	Gastroenterologist
	Infusion	Yes	Yes	PCP

Inpatient