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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.
]