What information is required to request prior plan approval?
Please utilize the checklist below as a guideline to ensure you have all the necessary information before requesting prior plan approval: • Member identification number, name, date of birth, and health plan • Ordering physician information • Imaging provider information • Imaging exam(s) being requested (body part, right, left or bilateral) • Patient diagnosis (suspected or confirmed) • Clinical symptoms/indications (intensity/duration) For complex cases, more information may be necessary, including: • Results of treatment history (previous tests, duration of previous therapy, relevant clinical medical history)
