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Upcoming changes to precertification requirements for outpatient radiation therapy

October 1, 2014

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Effective January 1, 2015, precertification will be required for outpatient radiation therapy for all commercial and Medicare Advantage HMO and PPO members. Independence is working with CareCore National, LLC (CareCore), an independent company, to manage precertification requests for outpatient, non-emergent radiation therapy services. Precertification is not required when radiation therapy is rendered in the inpatient hospital setting.

To initiate precertification for outpatient radiation therapy, a new option will be added to the NaviNet® web portal within the Authorizations transaction that will link to CareCore's provider portal. Providers will also be able to initiate precertification requests by calling CareCore directly at 1-866-686-2649.

Network radiation therapy centers will receive a letter describing the new precertification process through CareCore in greater detail. Additionally, look for more information about this change in future editions of Partners in Health UpdateSM.

Note: This precertification requirement does not apply to Federal Employee Program or Comprehensive Major Medical members.


Precertification for other radiology services

Precertification requests for all high-technology diagnostic imaging services (e.g., CT, MRI, PET) will continue to be handled through the current process with AIM Specialty Health®, an independent company.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

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