Prior Authorization Requests for Advanced Imaging
This file provides detailed instructions for participating providers with Avera Health Plans to submit prior authorization requests for advanced imaging. It covers the quick access guide, step-by-step procedure selection, and clinical collection phase. Additionally, it includes information on approvals and denials, modifications to cases, and contact details for CareCore National.
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How do I fill this out?
To fill out this form, start by logging into your CareCore National account and initiating a prior authorization request. You will be guided through a series of steps including selecting the referring physician, entering patient information, and providing details for the procedure and facility. Follow the prompts to complete the clinical collection phase and submit your case.
How to fill out the Prior Authorization Requests for Advanced Imaging?
1
Log into your CareCore National account.
2
Select the referring physician and enter patient details.
3
Choose the procedure and facility.
4
Complete the clinical collection phase.
5
Submit your case for approval or denial.
Who needs the Prior Authorization Requests for Advanced Imaging?
1
Participating providers with Avera Health Plans need this file to initiate prior authorization requests.
2
Physicians need this file to certify clinical procedures for advanced imaging.
3
Medical staff need this file to ensure compliance with authorization requirements.
4
Patients need this file to understand the process for obtaining prior authorization.
5
Healthcare administrators need this file to manage and track authorization requests.
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Save and download the edited PDF for submission.
What are the instructions for submitting this form?
To submit this form, log in to your CareCore National account at www.CareCoreNational.com. Complete the required fields as instructed, and ensure all information is accurate. Submit your request online to receive an Authorization/Notification Number upon approval. For modifications or additional information, contact CareCore National at 1 (866) 668-8295. It is recommended to keep a printed copy of the authorization for your records. Follow all steps carefully to ensure timely processing and avoid denials.
What are the important dates for this form in 2024 and 2025?
For the years 2024 and 2025, ensure that you submit prior authorization requests in a timely manner to avoid delays in medical imaging procedures. The expiration date for authorizations will be provided upon approval.
What is the purpose of this form?
The purpose of this form is to facilitate the submission of prior authorization requests for advanced imaging by participating providers with Avera Health Plans. By following the outlined steps, healthcare providers can ensure that necessary imaging procedures receive timely approval based on medical necessity. This form streamlines the process, reducing administrative burden and enhancing patient care by preventing delays in diagnostic imaging.
Tell me about this form and its components and fields line-by-line.
- 1. User ID and Password: Credentials required to log into the CareCore National system.
- 2. Referring Physician: Selection of the physician who is referring the patient for the imaging procedure.
- 3. Contact Information: Details of the contact person including phone and fax numbers.
- 4. Patient Information: Details about the patient including ID, date of birth, and last name.
- 5. Procedure Details: Information about the procedure including CPT code, description, and expected date.
- 6. ICD-9 Code: Diagnosis code related to the imaging procedure.
- 7. Rendering Facility: Details about the facility where the procedure will be performed.
- 8. Clinical Collection: Set of questions related to the clinical necessity of the procedure.
What happens if I fail to submit this form?
Failure to submit this form may result in delays or denials for the requested imaging procedures. It is crucial to follow the steps and provide accurate information.
- Delays: Medical imaging procedures may be delayed, affecting patient care.
- Denials: Requests may be denied due to insufficient information or failure to follow the process.
How do I know when to use this form?
- 1. Advanced Imaging Requests: When requesting authorization for procedures like MRI, CT scans, etc.
- 2. Clinical Certification: To certify the medical necessity of imaging procedures.
- 3. Patient Eligibility Verification: To check patient eligibility for the requested procedure.
Frequently Asked Question
How do I submit a prior authorization request using this file?
Log into CareCore National, follow the steps to select the physician, enter patient and procedure details, complete the clinical collection phase, and submit the case.
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What information is required for the clinical collection phase?
You will need to answer a set of questions based on the requested CPT code and provide accurate information.
What should I do if my case is denied?
If your case is denied, you can enter additional information for clinical review or call CareCore National for further assistance.
How can I verify patient eligibility?
Use the 'Eligibility Lookup' feature by entering the patient's ID, date of birth, and last name, and select the appropriate patient from the provided list.
What is the process for modifying a case?
The ordering physician can call CareCore National and provide the Authorization/Notification Number or Case Number to make modifications.
Where can I find provider resources and tutorials?
Visit www.CareCoreNational.com to access various provider resources, tools, and process tutorials.
How do I ensure the information provided is accurate?
Review all entered information carefully, check the acknowledgement box confirming accuracy, and submit the case for processing.
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