Precertification of Advanced Imaging Services

Effective April 1, 2006, Preferred Medical Doctor (PMD) referring physicians will be required to obtain a precertification from CareCore National (CCN) prior to scheduling Positron Emission Tomography (PET) Scans for all referrals to Blue Cross PRP providers practicing in the state of Alabama (and its contiguous counties). Computed Tomography (CT) and Computed Tomography Angiography (CTA), Magnetic Resonance Imaging (MRIs) and Magnetic Resonance Angiography (MRAs) precertification will be added later in 2006.

The precertification applies to physician owned and office based imaging, freestanding imaging facilities, and hospital outpatient referrals.

Please note that this is a precertification and is required for outpatient services only. Imaging services ordered during treatment of a patient while in the emergency room, from an Observation Unit, or during inpatient stays do not require precertification.

Precertification requests can be initiated using one of three methods. You may precertify a PET scan by calling CCN toll free at 1 866 803-8002, faxing to CCN at 1 845 298-1490, or initiating the request electronically via the Blue Cross web site at www.bcbsal.com.

If a referring physician fails to obtain a precertification from CCN or if the precertification is not approved due to lack of medical necessity, Blue Cross will deny reimbursement to the provider/facility that performed the radiology procedure(s) and the patient will be held harmless.

Instructions for completing a precertification request will be available on the web site. First time referring physicians must register with CCN in order to submit precertification requests via our web site www.bcbsal.com. Instructions will be provided for this first time registration process. Online registration is only required for filing precertifications through the web site.

We encourage radiology providers to verify precertification by accessing the precertification look up tool on our web site at www.bcbsal.com. Instructions will be provided.

Click here to view a complete list of PET, CT, CTA, MRI and MRA Physicians' Current Procedural Terminology (CPT) codes that require precertification.

For questions regarding the Radiology Management Program or your obligations related to the precertification process please contact your Network Services Representative .