Is a paper referral still required for non-AIS?
No, paper or electronic referrals are not required for radiology/imaging services rendered at facilities*, as long as the services are scheduled through the scheduling line. The tracking number given will replace the need for the paper referral (for Horizon HMO, Horizon POS and Medicare Advantage patients). *Effective November 1, 2006, Horizons claim processing systems have been updated so that paper referrals will no longer be required for routine radiology procedures such as X-rays, ultrasounds, and mammograms rendered in the Outpatient Department of the hospital. As of November 1st, tracking numbers can be utilized in lieu of paper referrals for these procedures. Please Note: Prior authorization/pre-service medical necessity reviews are still required for the Advanced Imaging Services (MRI/MRA, CT/CTA, PET Scans, Nuclear Medicine and Nuclear Cardiology).
