Wednesday, 11 July 2012

Fallon Community Health Plan Radiology Authorization Program

Fallon Community Health Plan has contracted with MedSolutions to do radiology prior authorization process effective from January 1, 2010. All MR, CT, PET & NCM services require prior authorization from MedSolutions.

Services require authorization:
  • All outpatients, non-emergent, diagnostic advanced imaging services including
  • CT
  • MR
  • PET
Services not require authorization:
  • Inpatient radiology
  • Nuclear Cardiology (NCM/MPI)
  • Radiology testing done in the Emergency Room
  • 23 hour observation
  • Outpatient radiology services other than those indicated
How can we request authorization from MedSolutions?

We can request authorization from MedSolutions in three ways as below.
  • Website       - (Registration required)
  • Phone          -        By calling 888-693-3211 (From 8AM to 9PM)
  • Fax              -        We can fax our request to 888-693-3210 (Fax form available at MedSolutions web portal, other fax forms cannot accepted)
What we need to request authorization in above ways?
  • The patient’s name & address
  • The current Member ID
  • The working or differential diagnosis
  • Prior tests, lab work and/or imaging performed related to this diagnosis
  • Notes from the patient’s last visit related to the diagnosis
  • Type and duration of treatment performed to date for the diagnosis
Authorization will be faxed to ordering physician and facility upon approval. We need add this authorization in our claims and needs to be submitted to Fallon Community Health Plan.


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