Friday, 20 July 2012

Health New England has partnered with MedSolutions to provide prior authorization for Radiology services

Effective from December 1, 2010 select CT, MR, Nuclear Cardiac, PET, and Sleep Apnea imaging studies require prior authorization from MedSolutions.

Services require prior authorization

All outpatient, non-emergent, diagnostic imaging services including
  • MR
  • CT
  • PET
  • Nuclear Cardiology Imaging (in-office only)
Services do not require authorization
  • Inpatient radiology
  • Radiology testing done in the Emergency Room
  • 23 hour observation
What we need to request prior authorization?
  • 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
How can we request prior authorization from MedSolutions?
  • Website       - (registration required)
  • Phone          -        888-693-3211(Monday to Friday @ 8.00 AM to 9.00 PM)
  • Fax              -        Fax forms needs to sent @ 888-693-3210 (Fax forms available at MedSolutions web portal)
Authorization will be faxed to the ordering physician and requested facility upon review.


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