Navigating the complexities of prior authorization This grid is an example of one health system’s prior authorization requirements for various imaging and other tests. In some instances, clinical decision support (CDS) can . Note: The tests listed here are not the only tests that require prior authorization; they are the tests known to require prior authorization with the insurance providers listed. Commercial providers, Medicaid HMO and out-of-state Blue Cross Blue Shield not listed here should be contacted for every high-dollar test in order to determine prior authorization requirements. Because clinical information is required for prior authorization, the patient and provider are responsible for beginning the prior authorization process. All generic insurance plan providers should be called to check on prior authorization requirements, as plans vary. PRIOR AUTHORIZATION REQUIREMENTS Priority Health Upper BCBS / Blue Molina (PH), PH United Aetna McLaren Peninsula Tricare Medicare Care Humana Cigna Healthcare Meridian Medicare Healthcare PPO PPO Health Prime + Blue Network of MI & PH Plan Medicaid RADIATION SERVICES CT/CTA X (even if X X X X X X X X X secondary (Anesthesia to auto, (when work performed comp or with liability) radiology testing) MRI X X X X X X X X X (Anesthesia (when performed with radiology testing) MRA X X X X X X X X (Anesthesia (when performed with
Navigating the complexities of prior authorization This grid is an example of one health system’s prior authorization requirements for various imaging and other tests. In some instances, clinical decision support (CDS) can . Note: The tests listed here are not the only tests that require prior authorization; they are the tests known to require prior authorization with the insurance providers listed. Commercial providers, Medicaid HMO and out-of-state Blue Cross Blue Shield not listed here should be contacted for every high-dollar test in order to determine prior authorization requirements. Because clinical information is required for prior authorization, the patient and provider are responsible for beginning the prior authorization process. All generic insurance plan providers should be called to check on prior authorization requirements, as plans vary. PRIOR AUTHORIZATION REQUIREMENTS Priority Health (PH), PH Medicare & PH Medicaid BCBS / Medicare + Blue Blue Care Network United Healthcare Humana Cigna Aetna PPO McLaren PPO Molina Healthcare of MI Meridian Upper Peninsula Health Plan Tricare Prime RADIATION SERVICES CT/CTA X (even if secondary to auto, work comp or liability) X X X X X X X X (Anesthesia (when performed with radiology testing) X MRI X X X X X X X X (Anesthesia (when performed with radiology testing) X MRA X X X X X X X (Anesthesia (when performed with X
10.1001stepsforward.2017.0100supp3.docx