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For purpose of coverage determinations and precertifications of selected complex imaging studies, Blue Cross and Blue Shield of Alabama defines “Urgent” medical conditions or situations as:
A condition or situation resulting from an illness or injury which calls for immediate attention and which if left unattended or untreated by medical personnel for a period of four or more hours will worsen and further endanger the health of the patient.
For urgent cases during CareCore National's (CCN's) regular business hours (Monday - Friday from 7 a.m. - 6 p.m. Central Time), please initiate those requests by telephoning CCN at 1-866-803-8002 and clearly advising the intake coordinator that the case is urgent. If the clinical reviewer is unable to approve the case, the referring physician may join the call and request to speak directly with one of CCN’s physicians to expedite the urgent request. This physician to physician discussion should allow for precertification determination by the conclusion of the call.
For urgent requests after CCN’s normal business hours, a weekend or a holiday, the referring provider should proceed with ordering the imaging study. The referring provider will need to request the precertification within two business days of the service by providing the clinical indications for the examination, including the reason it was deemed urgent. The medical necessity criteria will still be applied.
Upon approval, precertification approval numbers will be issued and posted to ProviderAccess.
Last Updated August 2013