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Friday, 10 August 2012

Health Net Health Plan of Oregon has contracted with MedSolutions to provide authorization for Radiology claims

Effective from June 18, 2012 all outpatient elective CT, MR and PET studies require prior authorization from MedSolutions for Health Net Health Plan of Oregon members.

Services require prior authorization
All outpatient, non-emergent, diagnostic advanced imaging services, including:
  • CT
  • MR
  • PET
Services do not require prior authorization
  • Inpatient radiology
  • Radiology testing done in the emergency room
  • 23-hour observation
  • Outpatient radiology services other than those indicated

What we need to request prior authorization
  • Member name and address
  • Member ID
  • Working or differential diagnosis
  • Prior tests, laboratory work and/or imaging performed related to this diagnosis
  • Notes from the member’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?

We can request prior authorization from MedSolutions in three methods as below
  • Website       -        www.medsolutionsonline.com (one time registration required)
  • Phone                   -        888-693-3211 (Monday to Friday @ 7AM to 8PM CST)
  • Fax              -        888-693-3210(fax forms available in MedSolutions web portal)
Authorization will be faxed to ordering physician and rendering facility.

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