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PMD physicians, Participating Chiropractors, Preferred Certified Registered Nurse Practitioners and Preferred Physician Assistants are required to obtain a precertification from CareCore National (CCN) prior to scheduling PET scans, CT/CTAs and MRI/MRAs. The precertification requirement applies to all referrals to Blue Cross and Blue Shield of Alabama providers practicing in the state of Alabama (and its contiguous counties). This requirement only 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 request precertifications for PET scans, CT/CTAs and MRI/MRAs by calling CCN toll-free at 1-866-803-8002 or online via ProviderAccess. Be sure to verify benefits on each individual patient to see if they are exempt from the precertification requirement.
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 diagnostic provider will be denied and the patient will be held harmless (the patient cannot be billed or otherwise held financially responsible for payment of the service).
We encourage radiology providers to verify precertification status via ProviderAccess on our website at www.bcbsal.com. Please be sure to include the Unique Provider Identification Number (UPIN) of the referring physician on your diagnostic image claim.
Last Updated August 2013