Auth Guideline-number of BUSINESS days to schedule based on insurance carrier 

Auth requirements:

Health Choice/Health Choice Generations: OB US is 5-7 days TAT, DUPLEX/DOPPLER is 5-7 day minimum TAT

Tricare: All US, MG, BD, MRI & CT require auth- 14 days minimum TAT

Alignment: US- 7 days minimum TAT

Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT (In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping and Prostate and out of network for ALL CT except CT lung, CTA for PE, CTA runoff and patients over 400 lbs.  

Mercy Care/Mercy Care Advantage: US (Elastrography) cpt 76981 is a 14 day minimum TAT

Scan Health: ALL Breast Imaging - 7 day minimum TAT

Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.

Humana FL (Only) All modalities - Schedule 9 days out.  Add-Ons ONLY allowed if patient has referral/authorization number on hand.

MERCY CARE UPDATE:

The Mercy Care drop down has changed in EXA.  Please use the new one below and this is ONLY being used for patients that state "Mercy Care'.  This should not be used if the patient has Mercy Care Advantage or Mercy Care RBHA.

COMMONLY MISCHEDULED PROCEDURES

Banner Aetna Guidelines:

• The card will say Multi Tier or Broad Network

• Alpha prefix: BNE

• Or if they're a banner employee

*We accept*

State Medicaid is NOT covered outside of the issued state

If patient has a Medicaid/State Funded insurance plan, they cannot be offered self-pay as another option.

Contracted insurers AZ