Partners Radiology
Prior Authorization Grid
Updates completed by Maryellen O'Dea (modea@partners.org) If you would like to print the grid (not recommended), you may want to adjust the Page setup to the following:  Change to landscape and decrease margins to minimum settings - approximately .23
All links listed in the grid - go to Payer_Links (at the bottom of the page) for easy access
Payer Radiology Service/Tests
Payer Contact Information
Lead Time for Approval Process Payer Confirmation
Aetna                        MA only                    Updated 10/6/09 Pre-Auth for MRI/MRA, CT/CTA, PET, Nuclear Cardiology.  For Interventional Radiology authorization contact the members plan directly - not handled by Medsolutions.   Medsolutions - 1-888-693-3211 - OPTION 1 / Fax number 1-888-693-3210 for a pre-certification form  online go to www.medsolutionsonline.com 1-2 business days prior to test, 1 week is preferable Referring physician must obtain authorization from Medsolutions by calling intake coordinator, faxing a pre-certification request form or on-line via the website.  Pre-cert valid for 90 days from date-of-service
Aetna                        All states                 Updated 10/9/09 Pre-Auth for MRI/MRA, CT/CTA, PET, Nuclear Cardiology.  For Interventional Radiology authorization contact the members plan directly - not handled by Medsolutions.   http://www.aetna.com/provider/medical/resource_med/coverage_med/precertification_policy_att_a12-12.html 1-2 business days prior to test, 1 week is preferable Use link to identify correct contact information.  Enter CPT code and the contacts are listed by state.  Web sites and phone numbers are provided on through this link.   Varies
BMC HealthNet Plan 10/6/09 MRI/MRA, CT/CTA, Nuclear Cardiology Imaging Studies, and PET Scans Medsolutions - 1-888-693-3211 - follow prompts / fax - 1-888-693-3210 Can also start prior auth process online at www.medsolutionsonline.com                       BMC HealthNet Plan info:  800-900-1451 (Provider Line) 888-566-0008 (Pre-Auth Department) or www.bmchp.org            Some patients may not be eligible for treatment outside of BMC.                                                                                                                                                                                                                                        1-2 business days prior to test, 1 week is preferable See Plan policy for coverage criteria:  The following non-emergent outpatient radiology services require Plan Review:  CAD Breast MRI, Cardiac CT Detection of Coronary Artery Calcium, CTA of the Coronary Arteries, CT Cerebral Perfusion of Imaging, CT Colonography screening, CT Virtual Bronchoscopy, CT Whole Body Screenign, Electromagnetic Navigation Bronchoscopy, High Field MRI, Low Field MRI, Mangnetic Resonance Neurography (MRN), Magnetic Soruce Imaging and Magentoencephalography, Naviscan PET, and Positional MRI Pre-cert valid for 60 days from date-of-service
Massachusetts BlueCross/BlueShield (BCBSMA) HMO & POS              Updated 10/6/09 CT/CTA, MRI/MRA, PET, Nuclear Cardiology, Virtual Colonoscopy (screen or diagnostic), Nuclear Stress Test, Coronary CT American Imaging Management (AIM)  1-866-745-1783 >> Option #1:  To Initiate Referral, Option #2: Ordering Physicians, Option #3:  Inquire on status, Option #4:  Reconsideration, Option #5 Web assistance.    http://www.americanimaging.net/   CUSTOMER SERVICE Center: 1-800-252-2021 1 business day prior to test BWH physicians must obtain notification number if the test is not ordered in Percipio. If the test is ordered in Percipio an automatic request  for the notification number will be submitted directly to AIM. Non-MGH physicians are required to call AIM to obtain Pre-Cert. MGH physicians call for Pre-cert if not scheduled in ROE. *January 1, 2008 - Expansion of Radiology Management Program to include co-pays. The MGH/PO radiology groups are working with BCBS offline on this. Will keep you posted.
 Authorization number is valid for 60 days from date-of-service
Anthem BC/BS CT/ME/NH/CO/NV/CA                        Updated 10/6/09 MRI/MRA, CT/CTA, PET , Nuclear Cardiology American Imaging Management (AIM) http://www.americanimaging.net/               1-866-714-1107 Option1=CT, Option2=ME, Option3=NH; then option 1                                          1-877-291-0366 Option1=CO, Option2=NV; then option 1.                                                      1-877-291-0360:  CA - option 1 Prior to scheduling - preferably as soon as possible Referring physician must obtain precertification by calling AIM or using the website https://providerportal.com/ Authorization is valid for 30 days                      
Rhode Island, Delaware, and Tennesse BCBS               Updated 10/6/09 Radiology Notification for: CT/CTA, MRI/MRA, PET, Nuclear Cardiology - Any Radiology Procedure Medsolultions 1-888-233-8158    For further details please see https://www.bcbsri.com/BCBSRIWeb/pdf/3_Ways_Prior_Authorization121707.pdf Prior to Exam Requests can be submitted via phone 1-888-233-8158 or fax  or online at www.medsolutions.com Usually between 60 and 90 days
BlueCross/BlueShield (all other states)      Information depends on the state.                 Confirmed 10/9/09 CT/CTA, MRI/MRA, PET, Nuclear Cardiology AND authorization for Interventional Radiology BCBSA 1-800-676-2583   Option #4 (automated line) Dependent on the State  Call out-of-state insurance Pre-cert or authorization verification Call out-of-state insurance Pre-cert or authorization verification
CIGNA HMO                                  Info confirmed for MA - varies by state            Updated 10/9/09 CT/CTA, MRI/MRA, PET Medsolutions - 1-888-693-3211 - OPTION 1 / Fax number for a pre-certification form 1-888-693-3210 or online www.medsolutionsonline.com 1-2 business days prior to test, 1 week is preferable Must obtain Pre-Cert or registration number prior to scheduling from Medsolutions by calling the intake coordinator, faxing a precertification request form, or online via the website. Pre-cert valid for 90 days from date-of-service
CIGNA Carelink Members             Updated 10/9/09 CT/CTA, MRI/MRA, PET, Nuclear Cardiology CIGNA Healthcare 1-800-558-3644 option#1 or 1-800-558-7478.  Also online at www.cignaforhcp.com   Tufts health Plan:  1-800-244-6224 1 business day prior to test, preferably at least a week.   Check back of CareLink ID card for authorization requirements or call CIGNA 1-800-558-3644 option1, or www.cignaforhcp.com, or call Tufts @ 1-800-244-6224.  To extend an authorization call 1-800-562-6833.   CIGNA healthcare authorization turnaround is 24 hours for urgent care and 48 hours for elective service.  Authorization is valid for 90 days
Connecticare                    Updated 10/6/09 CT, MRI/MRA, PET, Nuclear Cardiology NIA                                                 Connecticare  1-877-607-2363 option 1               or medicare 877-224-8230        www.radmd.com 2 weeks prior to scheduling is preferable Referring physician must obtain authorization by calling Connecticare prior-auth is valid for 30 days from the date of authorization
Fallon Community Healthplan                      Updated 10/7/09 CT/CTA, MRI/MRA, PET, Nuclear Cardiology Medsolutions - 1-888-693-3211 - OPTION 1 / Fax number 1-888693-3210 for a pre-certification form online www.medsolutionsonline.com 1-2 business days prior to test, 1 week is preferable Contact MedSolutions at 1-800-575-4417 - OPTION 1 - Fallon can also be contacted for specific pre-auth information with the number  located on the patients insurance card.  Listed Customer Service number is 1-866-275-3247 extension 69968 Authorization number is valid for 90 days
Harvard Pilgrim Health Care (HPHC)                  Updated 10/6/09 CT/CTA, MRI/MRA, PET, Nuclear Cardiology National Imaging Associates (NIA)                          1-800-642-7543 option 1          www.radmd.com Prior to scheduling BWH physicians must obtain notification number if the test is not ordered in Percipio. If the test is ordered in Percipio an automatic request  for the notification number will be submitted directly to NIA. Non-MGH physicians are required to call NIA to obtain Pre-Cert. MGH physicians call for Pre-cert if not scheduled in ROE.  Authorization number is valid for 30 days from date-of-service
(HPHC) Choice and Choice Plus with Passport Connect  Updated 10/7/09 Imaging Exams (MRI/MRA, CT/CTA, Nuclear Cardiology) United Healthcare 1-800-708-4414 Option1:IDs starting w/ HP, Option2:All numeric IDs.  Fax: 1-866-889-8061  www.unitedhealthcareonline.com.  Authorizations are provided by NIA 1-800-642-7543 www.radmd.com Prior to scheduling Approval is done online or via phone as listed in the contact field. Some patients with Passport Connect - an online member service may not require prior auth.   30 days from the scheduled date of service.  
Health New England                      Updated 10/6/09 CT, MRI, PET, Nuclear Contact NIA 1-888-642-4815 option 1    http://www.radmd.com 1 business day prior to appointment Referring MD is required to obtain authorization prior to the scheduled appointment Authorization is valid for 60 days
GIC (Commonwealth Indemnity Plan)                      Group #131192                   Updated 10/6/09                MRI & CT of the Abdomen/Pelvis, Cervical Spine, Lumbosacral spine, Thoracic Spine, Thoracic Cavity and MRI of the knee Unicare Commonwealth Service Center   1-800-442-9300  Option 2 then option 1 and 2 for authorization.                 http://www.unicare-cip.com/mcrecsbasicplus.html        http://www.unicarestateplan.com/ 7 days prior to test Referring physician must obtain Pre-Cert by phone or fax 7 days prior to date-of-service.  Fax number is 978-474-6800 Authorization is valid only for the specific date of the exam
Great-West Healthcare                           Updated 10/7/09 CT/CTA, MRI/MRA, PET Medsolutions - 1-888-693-3211 - OPTION 1 / Fax number 1-888-693-3210 for a pre-certification form online www.medsolutionsonline.com 1-2 business days prior to test, 1 week is preferable Referring physician must obtain authorization from Medsolutions by calling the intake coordinator, faxing a precertification request form or online via the website. Pre-cert valid for 30 days from date-of-service
Maine Medicaid                     Updated 10/7/09 Any test performed out of the state of Maine Schaller Anderson     www.schalleranderson.com                             The letter of Medical Necessity  must include: Physician’s letter must include:
a. Patient’s name; b. Patient’s MedicaidID # c. Diagnosis (describe diagnostic studies and treatment completed to date along with results, and clinical records upon which the referral has been made). Send clinical records to support diagnosis and referral;d. Names of physicians and/or facilities to whom the patient has previously been referred in Maine for diagnosis and/or treatment. e. Physicians consulted by attending physician relative to availability of diagnosis and/or recommended treatment in Maine. Send second opinion supporting out-of-state referral; f. Recommended treatment or further diagnostic work; g. Reasons why medical care cannot be provided in Maine or the next closest location outside the State; and h. Names of physicians and facility outside Maine to provide services and date of appointment if known. For prior auth help call phone 1-866-543-2387 option 5 or fax letter in to: 207-287-7643		 5-10 days lead time.  Ensure that prior authorization services is in place for the facility 30 days prior PCP must send in letter of medical necessity 30 days prior to the date of service - fax letter in to: 877-861-2615.                                    There is a 5 day turn around time for requests.  For more information call 1-866-543-2387 or visit www.schalleranderson.com.  Supporting clinicals and ICD-P codes are helpful.   Depends on the prior auth itself.  Usually 30 days (no more than 90)
MassHealth Medicaid            Updated 10/7/09 Breast MRI only Medical Imaging Exams: 1-800-862-8341 option2 and then 11 or 0.  Or 617-451-7017.  Customer Service Line for all other Exams: 1-800-841-2900 option 1, 8.  Technical Questions: 1-866-378-3789.  To obtain an authorization form visit http://www.mass.gov/Eeohhs2/docs/masshealth/provider_services/forms/prior_authorization_request.pdf. Or a prior authorization can be obtained online using https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/appmanager/provider/desktop?_nfpb=true&clickedBookNode=PortalFramework_portal_book_5&_pageLabel=homePage Requires 1-2 days notification prior to imaging.   For mailing in forms, Referring Physician must mail in an authorization form and letter of necessity 21 days prior to imaging exam.  Address is: MassHealth Attn: Prior Authorization Unit, P.O. Box 9153, Hingham MA 02043.  For other exams verify with customer service.  Otherwise either call the number listed or log in online to request the auth electronically at https://newmmis-portal.ehs.state.ma.us/EHSProviderPortal/appmanager/provider/desktop?_nfpb=true&clickedBookNode=PortalFramework_portal_book_5&_pageLabel=homePage Length of time for Pre-auth depends on exam
New Hampshire Medicaid               Updated 10/7/09 See CPT Code list on line:  http://www.mynewhampshirecare.com/PDFs/Prior_Auth_CPT_Codes_Imaging.pdf Schaller Anderson   www.mynewhampshirecare.com            Phone: 1-866-499-9335 Option2 then 3                  Fax: 1-866-499-9334  http://www.mynewhampshirecare.com/providers_medical.aspx 1-2 business days prior to test, 1 week is preferable Referring physician must obtain authorization from Schaller Anderson by faxing over completed form:  http://www.mynewhampshirecare.com/PDFs/272X_Diag_Imaging.pdf  Referring physician must sign form and include clinical documentation.   Prior authorization should be viable for 90 days
Neighborhood Health Plan (NHP)               Updated 10/7/09 CT/CTA, MRI/MRA, PET Medsolutions - 1-888-693-3211 - OPTION 1  / Fax number 1-888-693-3210 for a pre-certification form online www.medsolutionsonline.com 1-2 business days prior to test, 1 week is preferable BWH physicians must obtain notification number if the test is not ordered in Percipio. If the test is ordered in Percipio an automatic request  for the notification number will be submitted directly to Medsolutions. Non-MGH physicians are required to call Medsolutions to obtain Pre-Cert. MGH physicians call for Pre-cert if not scheduled in ROE. 
Prior authorization should be viable for 90 days
Network Health                          Updated 10/7/09 CT/CTA, MRI/MRA, PET Medsolutions - 1-888-693-3211 - follow prompts / fax - 1-888-693-3210 Can also start prior auth process online at Medsolutionsonline.com 1-2 business days prior to test, 1 week is preferable BWH physicians must obtain notification number if the test is not ordered in Percipio. If the test is ordered in Percipio an automatic request  for the notification number will be submitted directly to Medsolutions. Non-MGH physicians are required to call Medsolutions to obtain Pre-Cert. MGH physicians call for Pre-cert if not scheduled in ROE.  Prior authorization is viable for 90 days
Tricare Prime              Tricare (formerly Champus) (TRICARE smart - website)           Updated 10/9/09  MRI, MRA, SPECTs, PET - All imaging exams Health Net 1-877-874-2273.  Can be done on line @ www.hnfs.net, over the phone, or faxed.  {For inpatient - 1-800-977-7961 option 2.  Must be done via fax 916-351-4110 Jean Kaplan is the MA rep}  Authorizations are not needed for Tricare Standard patients.  Have NPI # ready.   Prior to scheduling Required referrals for civilian providers are always coordinated through Health Net Federal Services, Inc. (Health Net) by completing a Tricare Service Request /Notification form and faxing the form to 1-888-299-4181 Form can be found at: www.hnfs.net under forms library, 3rd page, 3rd option.  Or a request can be submitted online www.hnfs.net.   Prior authorization viable for upto 6 months
Tufts Health Plan (THP) in NH/MA/RI (HMO, POS, & PPS)               Updated 10/9/09 CT/CTA, MRI/MRA, PET, Nuclear Cardiology National Imaging Associates (NIA) 1-866-642-9703 option1 website www.radmd.com  Prior to scheduling BWH physicians must obtain notification number if the test is not ordered in Percipio. If the test is ordered in Percipio an automatic request for the notification number will be submitted directly to NIA. Non-MGH physicians are required to call NIA to obtain Pre-Cert. MGH physicians call for Pre-cert if not scheduled in ROE.  Authorization is valid for 60 days from the date of approval.
United Healthcare (UHC)                            Updated 10/9/09 Radiology Notification for: CT/CTA, MRI/MRA, PET, Nuclear Cardiology - Any Radiology Procedure United Healthcare 1-866-889-8054 option 1 / fax 1-866-889-8061  www.unitedhealthcareonline.com  General Info: 1-800-637-5792 Prior to scheduling Referring physician must obtain notification number by Web, phone, or fax. To obtain "R" go to: www.unitedhealthcareonline.com and click and Notifications link Radiology Notification is valid for 45 calendar days from the date-of-issue.
Unicare                                     Updated 10/9/09 This will vary for each patient and must be checked with the insurer Unicare 1-800-852-6127 or 1-888-234-8855.     If the member's group # is less than 6 digits a pre-auth may not be required.   Varies Referring physician must obtain precertification by phone or fax (800-610-6050).  Usually valid for 90 days from the date-of-authorization
Unicare              (American Imaging)                       Updated 10/9/09 MRI/MRA, CT/CTA, PET, Nuclear Cardiology AIM 1-866-714-1101 or www.americanimaging.net Prior to Exam and up to 2 days after Must obtain pre-certification by fax (800-610-0050), phone, or web (americanimaging.net) Usually valid for 90 days from the date-of-authorization