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In an effort to make the precertification process as efficient as possible, we offer the following instructions to avoid unnecessary work and delay:
- You may request precertification for PET scans, CT/CTA and MRI/MRA scans via one of the
- Access ProviderAccess via the Blue Cross website, www.bcbsal.com; or
- Call CCN toll-free at 1-866-803-8002.
Whether you prefer to initiate a precertification electronically via ProviderAccess or telephone, please provide the following information when you first contact CareCore National (CCN):
Identifying Information Should Include:
- The exact name of the patient, insurance information and correct contract number;
- The scan/test(s) being requested, with Current Procedural Terminology (CPT) codes, if available; and
- Contact information for the requesting and rendering doctors or facilities.
Clinical Information Should Include:
- The presumptive diagnosis or “working diagnosis” with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code, if available. The working diagnosis represents the physician’s best estimate of the likeliest cause of the patient’s complaints, after the history and physical are considered. The appropriate ICD-9-CM code will assist CCN in determining the clinical guidelines to apply to the precertification request. This includes the patient’s relevant signs and symptoms, listed in some detail, with severity and duration.
- Any other information that the doctor believes will help in evaluating the request such as prior diagnostic tests, consultation reports, etc.
- Any relevant treatments that have been tried for the condition in question, including dosage and duration for drugs, dates for other therapies, and their effectiveness.
This information should be provided to CCN via telephone or electronically via ProviderAccess.
Last Updated August 2013