keystone first prior authorization for mri

0000041898 00000 n 0000017744 00000 n 0000041962 00000 n 0000022668 00000 n 0000019344 00000 n This process is called “prior authorization.”. 0000042602 00000 n 0000021732 00000 n %PDF-1.4 %âãÏÓ 0000011740 00000 n Ordinarily, authorization should be in place before services are rendered; therefore, this process is often called "precertification” or “prior authorization.” Prior authorization requests are reviewed by FutureScripts ®, our independent pharmacy benefits manager, on behalf of Independence. The Prior authorization process has been a hot topic of debate in the healthcare industry for some time. If you are providing any of the services above, you should verify that the necessary authorization has been obtained. Prior Authorization User Guide January 2017 SCOPE This manual reviews the navigation and functionality the of Prior Authorization system specifically as it is utilized by CareFirst BlueCross BlueShield and/or CareFirst BlueChoice, Inc. (CareFirst) provider users. 0000022844 00000 n Sometimes, we need to approve medical services before you receive them. 0000000016 00000 n 0000013227 00000 n Services that require prior authorization by Keystone First VIP Choice (HMO SNP)** 0000008090 00000 n 0000008630 00000 n ; Prior Authorization is not required for emergency care. 0000042570 00000 n For questions about FEP members and their prior authorization, please call 800-469-7556. 0000013403 00000 n 0000022468 00000 n 0000042346 00000 n Our plan offers members an extensive provider network of physicians, specialists, pharmacies and hospitals. PET scan. 4 Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association. 0000024673 00000 n Please complete and fax to 1-855-809-9202. If an urgent or emergent emergency 0000042634 00000 n 0000041546 00000 n 0000033696 00000 n 0000042090 00000 n 0000025627 00000 n Here you can download policies and procedures specific to both ordering providers and imaging facilities. 0000025062 00000 n 0000013605 00000 n 0000008265 00000 n By phone: 1-888-559-1010 (toll-free) or 843-764-1988 in Charleston; Fax: Prior Authorization Request Form 1-866-368-4562; Prior authorization information. 0000010281 00000 n 0000011015 00000 n 0000004377 00000 n 0000025239 00000 n Any additional questions regarding prior authorization requests may be addressed by calling Keystone First's Utilization Management/Prior Authorization line at 1-800-521-6622. 0000132950 00000 n 0000007728 00000 n 0000020149 00000 n 0000042250 00000 n How To Guides; Register for a webinar; Archived Bulletins; Behavior Analysis. 0000052706 00000 n 0000013781 00000 n 0000006119 00000 n 0000015096 00000 n Ultrasound and diagnostic x-rays do not require prior authorization. If you are looking to fill out a Keystone First Prior Authorization Form to secure coverage for a non-preferred medication, you can download a PDF copy of this document here.. You also have the option of filling out and submitting an online prior authorization form through their website.. Fax: 1 (215) 937-5018; Prior Authorization Retro Fax: 1 (215) 937-737 0000042506 00000 n 0000025836 00000 n Providers are encouraged to review the Prior Authorization List frequently for changes. For questions about a prior authorization covered under the pharmacy benefit, please contact CVS Caremark* at 855-582-2038. AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices (CHC) reserves the right to adjust any payment made following a review of medical record and determination of medical necessity of services provided. 0000010824 00000 n 0000042218 00000 n 0000005073 00000 n MRI/MRA. 0000018909 00000 n trailer <]/Prev 143105>> startxref 0 %%EOF 181 0 obj <>stream 0000008456 00000 n 0000041834 00000 n 0000015061 00000 n Get specialty prior authorization forms. Prior authorization is not a guarantee of payment. 0000021297 00000 n 0000007373 00000 n 0000039893 00000 n 0000013028 00000 n 0000041802 00000 n 0000018536 00000 n 0000052185 00000 n Some services and medicines need to be approved as “medically necessary” by Keystone First Community HealthChoices before your PCP or other health care provider can help you to get these services. Prior authorization applies to services that are: • Outpatient • •Elective / Non-emergent • Diagnostic • Prior authorization does not apply to services that are performed in: Emergency room 23-hour observation • Inpatient It is the responsibility of the ordering provider to request prior authorization … 0000042666 00000 n 0000021140 00000 n 0000011915 00000 n View prior authorization requirement changes, effective November 1, 2020. 0000008998 00000 n The ordering physician or clinic is responsible for getting authorization. 0000014358 00000 n Radiology - The following services, when performed as an outpatient service, requires prior authorization by Keystone First’s radiology benefits vendor. An authorization for MRI in addition to MRA is not required, as a request for MR Angiography includes standard MRI imaging A single authorization for CPT codes 70486, 70487, 70488, or 76380 includes imaging of the entire maxillofacial area including face and sinuses. 0000041610 00000 n In 2015, Keystone First was rated among the "top Medicaid plans in Pennsylvania". 0000036149 00000 n Prior Authorization. Authorization is not a guarantee of payment. 0000007193 00000 n 0000024150 00000 n 0000007548 00000 n 0000022098 00000 n 0000023418 00000 n 0000048087 00000 n 0000017944 00000 n 0000042186 00000 n 0000041418 00000 n 0000022292 00000 n that require prior authorization. For both Generations Advantage and US Family Health Plan members, Prior Authorization may be requested by the member's PCP or by the servicing provider/facility. Positron Emission Tomography (PET) Magnetic Resonance Imaging (MRI)/Magnetic Resonance Angiography (MRA) Nuclear Cardiology/MPI 0000023039 00000 n 0000005391 00000 n 0000042026 00000 n BCBS of NC requires prior authorization for some outpatient procedures, including all CT/CTAs, MRI/MRAs, PET Scans and nuclear medicine cardiac scans. Most plans cannot require prior authorization before a member sees an OB-GYN or before emergency services are received. Instructions Prior Authorization. 0000044319 00000 n Prior authorization means that we have pre-approved a medical service. Emergency room, observation and inpatient imaging procedures do not require prior authorization from NIA. What is a prior authorization in healthcare? To submit a request for prior authorization, providers may: Call the prior authorization line at 1-855-294-7046 (*for behavioral health requests call 1-866-688-1137); Fill out this form (PDF) and fax it to 1-855-809-9202 (for behavioral health requests, fax to 1-855-396-5740). 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Prior authorization (PA) is … 0000042442 00000 n Please search under “Health First Florida / AdventHealth Advantage Plans”. 0000041770 00000 n 0000032292 00000 n 0000042474 00000 n Prior authorization information grid (PDF) 0000019714 00000 n 0000024850 00000 n 0000010456 00000 n 0000005754 00000 n 0000013980 00000 n MRI/MRA; PET scan; Obtaining authorization. 0000048576 00000 n These procedures will need to be authorized first then scheduled. Authorization requirement changes, effective November 1, 2020 clinic is responsible for getting authorization authorization before a sees. ; Behavior Analysis Name in the authorization List frequently for changes, Last ) DOB... For emergency care and their prior authorization form ( PDF ), including all inpatient. To obtain and check authorizations authorization could result in … prior authorization for information regarding prior is. Submitting a request for prior authorization means that we have pre-approved a service. 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