Most facilities require a physician-signed order form before performing diagnostic procedures. Referring physicians' requests for prior authorization are processed within 14 calendar days for routine organization determinations and 72 hours for expedited organization determinations after the receipt of all necessary information. An authorization is faxed to the ordering physician and requested facility, and mailed to the member.
All outpatient magnetic resonance (MR), computed tomography (CT), cardiac catheterization, positron emission tomography (PET), nuclear cardiac imaging (including myocardial perfusion imaging (MPI) and multigated acquisition (MUGA) studies), and sleep study diagnostic procedures require prior authorization. For Medicare Advantage (MA) enrollees undergoing PET in Medicare-specific studies, refer to the Medicare-Certified Facilities document under Utilization Management. In addition, for MA enrollees, all advanced diagnostic imaging (ADI) including MRI, CT, nuclear cardiac imaging, and PET must be performed by suppliers and facilities that are accredited, as defined by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), Section 135.
Providers must submit prior authorization requests to Health Net.