Susan G. Komen San Diego’s Breast Health Diagnostic Services Program

Imaging Centers

If you are an imaging center that does not have a signed agreement with Susan G. Komen San Diego, you will need to complete one in order to access the program for eligible patients. Please contact Lizzie Witting at lizzie@sdkomen.org for more details. 

Diagnostic Services Provider Claims

  • The diagnostic services provider must agree to accept Medicare rates and have a payment agreement on file with Komen San Diego. If payment agreement is not on file, Komen San Diego will contact the provider to establish a payment agreement.
  • The diagnostic service provider is responsible for ensuring all claims for payment are received by Komen San Diego within 60 days of the date of service.

Claims should be sent to:

By mail:

Claims Department
Susan G. Komen San Diego
Murphy Canyon Road, Suite 102
San Diego, CA 92123

By fax:

Claims Department
Susan G. Komen San Diego
(858) 751-5760

 

By email:

Claims Department
Susan G. Komen San Diego
claims@sdkomen.org



Patient Eligibility

To receive services from the Komen San Diego Breast Health Diagnostic Program, the patient must:

  • Be a resident of San Diego County
  • Not be eligible for Every Woman Counts (OR Every Woman Counts patients who need an MRI)
  • Not be eligible for Medi-Cal
  • Be at or below 300% of the Federal Poverty Guidelines (FLP). Click here to see the income guidelines.

 
Important: 

While we have tried to keep the process and authorization request forms as similar as possible to the ones you may be accustomed to from Health Quality Partners, there are a few important changes:

1. Surgical consults are no longer required prior to MRI.

2. Claims should contain the following information with no additional patient information (if additional information is on your invoice, please black it out before sending):

  • Patient Age
  • Patient Gender
  • Patient Zip Code
  • CPT Code for service rendered (see codes below) 
  • Cost of CPT Code for service rendered for Komen San Diego to pay
  • Komen San Diego Authorization Number

To access the program for eligible patients, you must first have a signed agreement with Komen San Diego (please contact lizzie@sdkomen.org for the agreement), and the Authorization Request Form must have been approved by Komen San Diego prior to the service.

Authorization Request Form

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thank you for the service you provide to the community. We look forward to working together to continue to provide access to breast health diagnostics in San Diego County. Please do not hesitate to reach out with any questions to Lizzie Wittig at (858) 573-2760 x104 or lizzie@sdkomen.org.