Precertification of Advanced Imaging Services

Since April 1, 2006, Preferred Medical Doctor (PMD) referring physicians have been required to obtain a precertification from CareCore National (CCN) prior to scheduling Positron Emission Tomography (PET) scans for all referrals to Blue Cross and Blue Shield of Alabama PRP providers practicing in the state of Alabama (and its contiguous counties). Since July 1, 2006, PMD physicians, Participating Chiropractors, Preferred Certified Registered Nurse Practitioners and Preferred Physician Assistants have been required to obtain a precertification from CCN for all Computerized Axial Tomography (CT) scans. Magnetic Resonance Image (MRI) was added to the precertification requirements effective November 1, 2006. The precertification applies to office based imaging, freestanding imaging facilities, and hospital outpatient referrals.

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.

You may precertify a PET scan by faxing the completed PET fax form to CCN toll-free at 1 866 466-6964.

You may request precertifications for CT scans and MRI's by calling CCN toll-free at 1 866 803-8002, faxing the completed form to CCN at 1 866 466-6964 or online via ProviderAccess.

If a referring physician fails to obtain a precertification from CCN or if the precertification is not approved due to lack of medical necessity the claim from the imaging provider will be denied and the patient will be held harmless.

We encourage imaging providers to verify precertification status via ProviderAccess on our web site at www.bcbsal.com or by calling CCN at 1 866 803-8002.

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

To help in your choice of the best imaging study for your patients, CareCore National has created a set of guidelines, indications and suggestions. We recognize that there is no substitute for your clinical judgment, but we have endeavored to bring to one location some current, evidence-based recommendations regarding imaging. We hope that the material provided in CCN's Physician Guidelines will provide some aid in choosing the proper study. This document will be updated as necessary.

Click here for Blue Cross and Blue Shield of Alabama Medical Policies.

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