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Prior Approval Program Information
High-tech imaging (scanning) procedures are one of the most rapidly rising medical
expenses. The following high-tech scans are not only causing premiums to increase;
most are exposing patients to higher doses of radiation.*
- PET scans
- CT scans
- MRI/MRA
- Nuclear cardiology
What is Arkansas Blue Cross and Blue Shield doing to help?
Arkansas Blue Cross has implemented a program that requires physicians to obtain
an authorization when ordering outpatient high-tech imaging procedures for their
patients. 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.
Simplifying The Process
The approval process generally is fast and efficient but, as with any new program,
there have been minor glitches. Arkansas Blue Cross is working to simplify the process
for physicians.
What Employers Need To Know
- If the physician fails to get an authorization, your covered employee will not be
held financially responsible if the service is provided by an in network facility.
- The imaging facility may not perform the scan on your covered employee until an
authorization has been received.
- Prior approval is not a guarantee of payment. Your employee’s benefit plan may have
exclusions or limitations that may apply.
For More Information
Contact the Regional
Office in your area.
*For more information, download Blue & You Winter 2005 (3 MB PDF), and read pages 16-18.
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