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Precertification of Advanced Imaging Services

Precertification of Advanced Imaging Services

Blue Cross and Blue Shield of Alabama network referring providers are required to obtain a precertification from CareCore National (CCN) for the following services prior to scheduling:

Referring providers include Preferred Medical Doctors, Blue Advantage®, Participating Chiropractors, Preferred Certified Registered Nurse Practitioners and Preferred Physician Assistants. Precertification applies to office-based imaging, freestanding imaging facilities and outpatient hospital 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, CTA/CT and MRIs by calling CCN toll-free at 1-866-803-8002 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 website at www.bcbsal.com or by calling CCN at 1-866-803-8002.

 pdf Click here to view a complete list of PET, CT, CTA, MRI and MRA 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 Provider Network Services Representative.