|
Prior Authorization
When To Seek Prior Approval
Some benefits provided by your Health Advantage health plan may require approval
in advance of receiving medical services.
Contact Customer Service if you have questions about prior
authorization.
The following services always require prior authorization:
-
All out-of-network services
-
Breast reductions (not related to cancer)
-
Enteral formula
-
IDET (Intradiscal Electrothermal Annuloplasty)
-
Select injectable medications
-
Swing bed care (prior approval by case management)
-
Transplants (excluding kidney and cornea)
High-Tech Scanning Procedures
Arkansas Blue Cross has implemented a new prior approval program
that requires physicians to obtain an authorization when ordering the following outpatient
high-tech imaging procedures for their patients.
- PET scans
- CT scans
- MRI/MRA
- Nuclear cardiology
Physicians are not required to obtain an authorization when these services are performed in an emergency room,
observation bed stay or for patients who are hospitalized.
|