Does MRI need prior authorization?

Insurance companies often will agree to cover MRIs if patients obtain pre-approval for the imaging. This process, called prior authorization, entails giving the insurer additional information about why the doctor has prescribed the scan and what circumstances, such as an injury, led to the order.

Aetna considers annual low-dose computed tomography (LDCT) scanning, also known as spiral CT or helical CT scanning, medically necessary for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years.

Does Aetna require pre authorization for MRI?

Some procedures (For instance, an MRI, CAT scan or surgery.) need approval in advance. Your doctor can ask for this approval up to six months ahead of time. You can share a copy of this guide with your doctor.

Does Aetna cover brain MRI?

Medical Necessity Aetna considers magnetic resonance imaging (MRI) medically necessary for appropriate indications without regard to the field strength or configuration of the MRI unit. Aetna considers intermediate and low field strength MRI units to be an acceptable alternative to standard full strength MRI units.

What is precertification for insurance?

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

What is the prefix for Aetna ID?

All Aetna Medicare Advantage plan members will have 12-digit member ID numbers beginning with 10. We will no longer use the ME prefix for Medicare Advantage plans after that date. Consol Energy will transition from ID numbers beginning with ME to those beginning with 10 on April 1, 2022.

Does Aetna require preauthorization?

Aetna Better Health of California requires prior authorization for select acute outpatient services and planned hospital admissions. Prior authorization is not required for emergency services. A current list of the services that require authorization is available on ProPAT, our online prior authorization search tool.

Why does Aetna require prior authorization?

The prior authorization process helps ensure that you are receiving quality, effective, safe, and timely care that is medically necessary. All decisions are backed by the latest scientific evidence and our board-certified medical directors.

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Aetna Prior Authorization Form Pdf

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Aetna Precertification Notification 503 Sunport Lane Orlando FL 32809 Phone 1-866-503-0857 FAX 1-888-267-3277 Injectable Medication Precertification Request Please indicate Start of treatment Ship to Doctor s office Patient Continuation of therapy Date needed Phone Dispensing Provider Today s date Other Aetna Specialty Pharmacy or Fax TIN PIN A. DIAGNOSIS INFORMATION Primary ICD-9 170. 0-170. 9 Malignant Neoplasm of Bone and Articular Cartilage 185. 0 Malignant Neoplasm of Prostate 198. 5 Secondary Malignant Neoplasm/Bone and Bone Marrow Other ICD-9 Code E. CLINICAL INFORMATION Does the patient have confirmed bone metastases from solid tumors F. PRESCRIPTION INFORMATION To be completed only if Aetna Specialty Pharmacy is Dispensing Provider MEDICATION STRENGTH DIRECTIONS QUANTITY REFILLS CPB 0804 If the prescriber is providing the drug the provider must verify benefits. 0 Malignant Neoplasm of Prostate 198. 5 Secondary Malignant Neoplasm/Bone and Bone Marrow Other ICD-9 Code E. CLINICAL INFORMATION Does the patient have confirmed bone metastases from solid tumors F. PRESCRIPTION INFORMATION To be completed only if Aetna Specialty Pharmacy is Dispensing Provider MEDICATION STRENGTH DIRECTIONS QUANTITY REFILLS CPB 0804 If the prescriber is providing the drug the provider must verify benefits. Prescriber s Signature Required by law if Aetna Specialty Pharmacy is the dispensing pharmacy. Interchange is mandated unless practitioner writes the words NO SUBSTITUTION in this space GR-68694 1-11 Date /. PATIENT INFORMATION First Name Last Name Address City Home Phone State Work Phone DOB Cell Phone Allergies Patient Current Weight B. INSURANCE INFORMATION Email lbs or kgs Aetna Member ID Group Insured Medicare Yes No If yes provide ID C. PRESCRIBER INFORMATION Patient Height Does patient have other coverage Medicaid inches or cms No Carrier Name Circle one M. D. D. O. N*P. P. A. Provider Email St* Lic* NPI Oncologist Hematologist Internal Medicine ZIP DEA Office Contact Name Specialty Circle one D. DIAGNOSIS INFORMATION Primary ICD-9 170. 0-170. 9 Malignant Neoplasm of Bone and Articular Cartilage 185. Prescriber s Signature Required by law if Aetna Specialty Pharmacy is the dispensing pharmacy. Interchange is mandated unless practitioner writes the words NO SUBSTITUTION in this space GR-68694 1-11 Date /. PATIENT INFORMATION First Name Last Name Address City Home Phone State Work Phone DOB Cell Phone Allergies Patient Current Weight B. INSURANCE INFORMATION Email lbs or kgs Aetna Member ID Group Insured Medicare Yes No If yes provide ID C. INSURANCE INFORMATION Email lbs or kgs Aetna Member ID Group Insured Medicare Yes No If yes provide ID C. PRESCRIBER INFORMATION Patient Height Does patient have other coverage Medicaid inches or cms No Carrier Name Circle one M. PRESCRIBER INFORMATION Patient Height Does patient have other coverage Medicaid inches or cms No Carrier Name Circle one M. D. D. O. N*P. P. A. Provider Email St* Lic* NPI Oncologist Hematologist Internal Medicine ZIP DEA Office Contact Name Specialty Circle one D.

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