Prior Authorization for an Extension of Approved Days Always check eligibility and benefits first, via the Availity ® Provider Portal or your preferred vendor, prior to rendering care and services.įor additional information, refer the Electronic Provider Access (EPA) FAQs located in the right navigation menu. Other services may also require preauthorization.Inpatient admissions (scheduled and/or nonemergent), certain outpatient services, emergent admissions/obstetric (request authorization within two (2) business days of the admission), requests for extensions and Plan65 Members when their Medicare Part A benefits have been exhausted.Services which may require Prior Authorization Send a completed Authorization Request form to (888) 746-6433 or (516) 746-6433.The following outlines the process for providers to submit prior authorization requests. Prior Authorization requests may also be submitted via FAX.Login credentials for EZ-Net are required. Mammography.Īll Other Services Require Prior AuthorizationĪ request for Prior Authorization can be submitted to HCP in one of two ways:ĮZ-Net is the preferred and most efficient way to submit a Prior Authorization (PA). Preventative care imaging studies, e.g.All studies associated with the provision of emergency care.All ultrasound studies of the abdomen and lower extremities performed in an office or freestanding (non-hospital based) outpatient imaging center when medically necessary.All plain film studies performed in an office or freestanding (non-hospital based) outpatient imaging center when medically necessary.MRI of Brain without contrast (only when ordered by a neurologist) (CPT 70551).CT Angiography of Chest (non-coronary) (CPT 71275).CT of Abdomen and Pelvis with/without contrast (CPT 74178).CT of Abdomen and Pelvis with contrast (CPT 74177).CT of Abdomen and Pelvis without contrast (CPT 74176).CT of Head without contrast (CPT 70450).The following radiology services can be obtained without Prior Authorization: In addition to being able to obtain plain films without Prior Authorization in the office setting or at a freestanding imaging center, Zwanger-Pesiri and RadNet facilities will provide additional imaging services with no PA required. Radiology Services Without Prior Authorization EmpireBCBS Medicare patients must utilize the services of AIM for imaging prior authorizations.įor additional assistance with urgent imaging (or other time-sensitive clinical needs), you can also contact the HCP RTR™ line. This will allow you to manage time-sensitive clinical conditions while avoiding unnecessary visits to the Emergency Department.Īt present, these additional services are only available to EmblemHealth patients whose PCP has a direct contract with HCP. A radiologist will quickly call you with the interpretation of the study. Your patient can be sent directly to one of Zwanger-Pesiri’s or RadNet’s free-standing facilities to complete the study. Our partnership with Zwanger-Pesiri and RadNet, two leading freestanding imaging organizations in NYC and LI, can bring real-time diagnostics to the busy Primary Care Practitioner. The key to an accurate diagnosis is based on performing the correct diagnostic studies during the most critical window of opportunity. Patients often present in the office setting with symptoms that can be difficult to diagnose on examination alone: cholecystitis vs gastritis diverticulitis vs constipation pulmonary embolism vs acid reflux deep vein thrombosis vs. Prior Authorization for Radiology Services
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