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MDNY Healthcare, Inc., in our continuing efforts to improve health and well being in the communities we serve, is pleased to announce a new Radiology Management Program that will allow us to work collaboratively toward that goal, while addressing quality and cost challenges in diagnostic imaging. MDNY is entering into an agreement with CareCore National, LLC (CCN) to assist in the management of non-emergency outpatient radiology/imaging services. CCN is a nationally recognized physician-owned radiology management services company. CCN will assist in ensuring appropriate radiology/imaging services for our members and provide clinical consultation to our participating providers.

The Radiology Management Program is designed to support referring physicians in their decision-making process, to promote patient safety by avoiding duplication of diagnostic services, to maximize customer benefits by providing the most up-to-date clinical and technical recommendations to your practice, and to minimize patient out-of-pocket costs through direction to a diagnostic facility that is participating in the MDNY network.

Effective March 1st 2006, MDNY referring physicians will be required to obtain pre-authorization for outpatient advanced imaging procedures. Enclosed you will find the following documents:

(Please note: This pre-authorization program applies to outpatient services only. Imaging services ordered during Emergency Room visits or inpatient stays do not require pre-authorization.)

If a referring physician fails to obtain a pre-authorization number from CareCore National, MDNY will deny reimbursement for the radiology services from the facility that performed the radiology procedure.

Important Factors Concerning MDNY’s Radiology Management Program:
• CareCore will begin accepting telephonic requests on February 15th, 2006 at 1-800-934-7153, for services to be rendered after March 1, 2006.
• MDNY will continue to process radiology claims. There is no claim delegation at this time.
• This pre-authorization process will not affect your current fee schedule.
• There will be no disruption to MDNY’s current physician and facility network.
• The ordering physician is responsible for obtaining the pre-authorization.
• Pre-authorization is valid for 45 days.
• One authorization number is issued per CPT Code.
Please contact MDNY’s Provider Relations Department at 1-800-707–MDNY (6369), prompt 3, with questions regarding this new program or your obligations related to the pre-authorization process. I appreciate your support and look forward to your assistance in ensuring that your patients, our members, continue to receive high quality diagnostic imaging services.

Sincerely,

Ronald Perrone, MD
Chief Medical Officer