Monday, November 15, 2010

radiology procedure code required referral - how many day can be allowed for retro authorization

Prior Authorization and Referral Requirements

For all MRI’s, MRA’s, CT scans, CTA’s, and PET scans performed on or after March 2, 2009, providers will be required to request prior authorization from MedSolutions. Scans performed as an inpatient hospital service, as an emergency room service, or for Medicaid recipients who are also covered by Medicare are exempt from the PA requirement.

Prior authorization requests for outpatient diagnostic imaging procedures may be made to MedSolutions by phone at (888) 693-3211 or by fax at (888) 693- 3210 during normal business hours 7:00 a.m. to 8:00 p.m. C.T. Requests can also be submitted through MedSolutions’ secure website at
www.MedSolutionsOnline.com. Requests by third party companies are not allowed. Only the performing provider (facility) or the referring/ordering provider may request prior authorization from MedSolutions. Prior authorization must be obtained prior to the test being performed. In the event
of an urgent situation (when the prior authorization cannot be obtained before the test is performed), a PA may be requested within 14 days from the date of service. The case must then meet the “urgent” criteria before it will be considered for review. Providers are allowed 30 days from the date of service
to submit a request to change or add a code to an approved case.

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