Provider Central

This article is for providers ordering high-technology radiology services

We have noticed an increase in appeals for denied authorizations for high-technology radiology services that subsequently were overturned when the provider submitted clinical documentation. To both minimize denials that require your office to spend time submitting appeals and help your patients get the appropriate care sooner, we’ve assembled a few tips.

Tips

• Carelon Medical Benefits Management, an independent company, manages several authorization programs on our behalf. Enter authorization requests using their secure ProviderPortal. It’s available when you log in to Provider Central.

• When a request requires further clinical review, a pop-up window asking for Additional Information will display, as shown below. Please add any other relevant information to the request and click Continue. Include relevant clinical information such as the results of previous studies (for example, labs, X-rays) and treatments, including their duration.

• Make sure you have pop-up blockers turned off since ProviderPortal uses pop-up boxes to prompt you through the system.

For more information about our authorization program, consult the high-technology radiology page on Provider Central.

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