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Thursday, 28 June 2012

Prior Authorization request for Wellcare, Staywell & Healthease Radiology Claims

Effective from June 1, 2010 Wellcare & Healthease of Florida has contracted with CareCore National to provide prior authorization for outpatient radiology services.

Below services require prior authorization from CareCore National

  • CT/CTA
  • MRI/MRA
  • PET
  • Nuclear Medicine
  • Nuclear Cardiology
  • OB Ultrasound

If above services rendered in following outpatient settings then we need to obtain prior authorization

  • Freestanding Imaging Center
  • Out-patient Hospital
  • Physician Office
  • Ambulatory Surgical Centers

How can we obtain prior authorization from CareCore National?

Authorization requests can be submitted via
We need below details to obtain the authorization using with anyone of above ways
  • Patient’s ID, name, date of birth
  • Physician’s information
  • Requested study and/or CPT code
  • Diagnosis code
  • Site for requested study
  • Clinical information pertaining to requested study

The following physian details will be required to request an authorization.

Web requests:
  • Must be a registered user
  • Site name, TIN or NPI
Phone requests:
  • Provider name
  • Verification of address and fax number
Fax requests:
A case number will be assigned every auth request for reference purpose but it cannot be considered as auth#. This case number is a 10 digit numeric value. Upon CareCore National review authorization number will be issued.

An authorization is in below format

A024389867-70460
(Alpha code + Numeric codes + CPT code)

Claim needs to be submitted with this authorization unless it will denied but there is no deviation in claim submission process.

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