Colglazier Demmel
Medical Clinic

Precertification Policies and Guidelines

Search Precert List

Precertification Contacts

Policies and Guidelines

Moving Forward Health Insurance PDF

Diagnostic Imaging Preauth

BCBS CA has many different plans and different phone numbers to call to verify. Go thru BCBS Finder #800-676-2583 opt 5 to get the correct plan.

Anthem National Precert PDF

Anthem National Precert PDF

Anthem National Precert PDF

Anthem National Precert PDF

Anthem National Precert PDF

2011 Regional Anthem Precert for IN, KY, MO, OH, and WI

Anthem Regional OptiNet Quick Reference Guide

Anthem Regional Precertification CPT Code List

Anthem National Precert PDF

Anthem National Precert PDF

2011 Regional Anthem Precert for IN, KY, MO, OH, and WI

Anthem National Precert PDF

Anthem National Precert PDF

Anthem National Precert PDF

Company requires Login to access precertification requirements.

Notification sometimes required.

BCBS Alabama MRI/MRA Precert Form

BCBS Alabama PET Precert Form

BCBS Alabama CT/CTA Precert Form

How to Verify Precert Requirements BCBSAL

PROCEDURES REQUIRING PRIOR AUTHORIZATION:CT Scan, Nuclear Cardiology, MRI/MRA, PET Scan. A separate authorization number is required for each procedure ordered

Blue Advantage Arkansas Precert

Out of Area Precert(XCP Prefix)

During Observation only for CT Scans, CTA, Echocardiography (Pre-notification and clinical information required), MRA, MRI, Nuclear Cardiology and PET Scans please call BCBSGA for approval.

A Radiology Quality Initiative (RQI) number is required by BCBSIL prior to ordering CT/CTA scans, MRI/MRA scans, Nuclear Cardiology studies, and PET scans for PPO and BlueChoice Select members.

BCBS Kansas Pre-certification Manual PDF

BCBS Kansas Provider Forms

Provider Info Pack BCBS Louisiana

Professional Office Provider Manual

BCBSMA Preauth PDF

Radiology Services: Pre-authorization is not required for non-Michigan providers.

BCBS Non-Michigan Provider Precert Requirements PDF

PET Scans Oncology must meet medical policy criteria(see website, provider, tools, med policies, view all, put in CPT or by name to search

Portal to BCBSMN Medical Policies

BCBS of Nebraska Precert Authorization Requirements PDF

BCBS of Nebraska Precert Authorization Requirements PDF

Pre-Auth Reference Manual BCBSNW

* CT/CTA scans, MRI/MRA scans, PET scans, Nuclear cardiology studies

Radiology Precert Portal

BCBS SC Radiology Reference Guide

BCBS Tennessee Preauthoriztion Requirements

BCBSTX RQI Pre-Authorization Page

Radiology Services (Elective) - CT, CTA, MRI, MRA, MRS & PET scans

Prior authorization medical necessity reviews are recommended for certain non-emergency outpatient radiology procedures (CT, MRI, MRA, PET, cardiac nuclear medicine) for Administrative Services Only (ASO), Direct Contracting and PPO plans. Review requests for services within California are performed by National Imaging Associates. Visit the NIA website to use this service, or call (888) NIA-BLUE (642-2583).

Blue Shield of California's Prior Authorization List

Medicare Advantage Prior Authorization

Pre-Service Review Request for Authorization Form

Provider Quick Reference Guide(See Page 4)

General Information Provider Manual(p. 32)

Michigan Phone:800-390-7102

Michigan Fax:888-577-5507

Ohio Phone:800-488-0134

Ohio Fax:888-752-0012

Ohio FAQ Prior Authorization

Ohio Prior Authorization Form

Michigan FAQ Prior Authorization

Michigan Prior Authorization Form

Magnolia Health NIA

Ordering Physicians Quick Reference Guide

Imaging Facilities Quick Reference Guide

Request For Prior Authorization Form

Precert. If NEBR will be transferred to CIGNA internal dept.

Prior Authorization

Coverage Policies and Criteria Model

CIGNA for Healthcare Professionals

Cigna Healthcare Provider Precert

PET Scans, CT, MRI

CT and PET?

Prior Authorization Quick Guide

Medicare Prior Authorization

CHCIowa Coventry Regional Identification Guide

CHCNE Preauthorization Quick Guide

Pre-Auth Forms (ZIP Archive)

Medicaid Fact Sheet

Medicaid Prior Authorization Guide(Selected Counties)

Advantra Prior Authorization Guide

Ordering Physician Quick Guide

Imaging Facility Quick Guide

Precert CPT Code List

Outpatient Imaging Program FAQs

RadMD Quick Start Guide

CHC Florida's Pre-Authorization Page

Medical Pre-Authorization Request Form

Prior Authorization List

PersonalCare Quick Reference Guide for Ordering Physicians

PersonalCare Quick Reference Guide for Imaging Facilities

NIA Radiology Benefit Management Program Q and A

RadMD Quick Start Guide for Requesting Exams

Services Requiring Preauthorization 2011

2011 Southern Health Provider Manual

Southern Health Quick Reference Guide For Ordering Providers

Southern Health Quick Reference Guide For Imaging Facilities

Prior Authorization Request Form PDF

Provider Manual PDF

Empire General Preauth PDF

Fixed Local Precert List

PET Scans, CT Scans, MRI/MRA, Nuclear Cardiology

Excellus BCBS Preauth PDF

Company requires Login to view precertification policies.

NO Retro's and has to get the precert/auth before getting benefits.

Prior Approval Form

Services typically requiring preauthorization include hospital inpatient or observation care, selected outpatient surgery (regardless of type of setting), high cost radiology (such as CT, MRI, IMRT, Bone Density, Whole Body or PET Scans), DME/Prosthetics/Orthotics, Home Care, Pain Management, Rehabilitation (Cardiac/Pulmonary/PT/OT/Speech), Sleep Studies, and services related to Infertility or Transplants.

Provider Manual

Now known as Assurant Health.

Prior Authorization Fact Sheet

Out of Area Precert(XCH Prefix)

Health Advantage Radiology Reference Guide

Suggest Pre Auth as only certain dx's are covered. FAX# (depends on the customer rep you visit with).

Highmark Prior Authorization Guide PDF

Prior Authorization Portal

2011 Radiology Codes Requiring Preauth

CT requires precert (have not called recently)

Keystone Health Plan East Flex and Personal Choice Flex

Keystone Health Plan East Non-Flex

Personal Choice Non-Flex

Children’s Health Insurance Program (CHIP)

adultBasic(SM)

Special Care(SM)

Keystone 65 HMO and Personal Choice 65 PPO

Services that do not require precertification

In the fall of 2007, HealthSmart, formerly The Parker Group, acquired the Interplan Health Group companies, which included Interplan Health Group (IHG), the Emerald Health Network (EHN), Preferred Plan, Inc. (PPI), Health Payors Organization (HPO) and Superien Health Network.

Precertification: Most employer groups require precertification for inpatient and outpatient hospital services. Refer to the member ID card for the telephone number for precertification.

PMCS Online Interplan Health

Kaiser Permanente Ohio Authorization Quick Reference

Kaiser Permanente Georgia Authorization Quick Reference

Specific radiology and imaging services: CT/CAT scan, MRI, MRA, NC and PET scan. You must contact the plan before receiving these services at 1-800-410-7778.

Plans and Benefits FAQ

Notification Required Call: 866-825-1550

Radiology Notification

Medical Management

Procedures Requiring Prior Authorization:CT/CTA,,MRI/MRA,PET Scan,Nuclear Stress (MPI),CCTA,Nuclear Cardiology

Procedures Requiring Prior Notification:Stress Echo

NIA Quick Reference for Ordering Physicians

Healthcare Strategies (MRI, CT, PET)

PET Scans require Precert/Auth

Advanced Imaging Precertification Letter to Providers

Precertification of Advanced Imaging Procedures FAQ

FAX Request for Precertification w/866-673-1742

FAX Request for Precertification w/866-673-0891

FAX Request for Precertification w/866-673-0876

Educational postcard for members about the precertification process

Fax info in with auth forms off of the website or complete online. Prime Remote Plan requires an active duty? Physician's office must complete.

Triwest Prior Authorization

800-601-7427 Ext. 888

CT, MRI, PET

Polysomnogram (Sleep Study CPT 95810)

For Medicare Advantage benefit plans, UnitedHealthcare requires prior authorization for the following defined set of advance outpatient imaging procedures: CT scan, MRI, MRA, PET scan, Nuclear Medicine, and Nuclear Cardiology.

UHC PDF which includes Prior Authorization Policies

Before providing non-emergency outpatient diagnostic imaging services performed in a freestanding imaging center, hospital outpatient setting, or in-office via physician-owned high-tech equipment require preauthorization: Computed Tomography (CT) scans, including CT chest, Computed Tomographic Angiography (CTA) scans, including CTA chest, Nuclear Cardiology (For example: SPECT scans, cardiolyte stress tests), Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI) including MRI upper extremity joint and MRI upper extremity non-joint; MRI lower extremity and MRI pelvis, Magnetic Resonance Angiography (MRA), Echocardiography (stress, resting transthoracic)

Wellmark Policies and Authorizations