Radiology authorizations
Low-tech radiology authorizations
Low-tech radiology services performed in participating provider offices do not require authorization. However, they are only payable when the participating provider is privileged under their specialty to perform them.
Learn about credentialing by specialty.
High-tech radiology authorizations
Participating providers:
Request prior authorization for most Priority Health patients through American Imaging Management (AIM) before ordering high-tech radiology studies and exams. See "Requesting high-tech imaging authorizations," below.
Out-of-network providers:
Request authorization for high-tech radiology services by completing the Medical Prior Authorization form (522KB PDF) or by calling the Provider Help Line if needed. Choose the "authorization" option.
Exceptions to the requirement for prior authorization of high-tech imaging studies
Prior authorization
is REQUIRED for: | EXCEPTIONS: |
|---|
- CT/CTA
- MRI
- MRA
- Nuclear cardiac studies
- PET scans
|
- Emergency department or urgent care facility
- Services related to same-day outpatient surgeries
- Inpatient stays
- Observation
- Patients covered by Priority Health Medigap (Medicare Supplement insurance) plans
- Gentex (group 783589) and Artiflex (group 773449) patients
|
Requesting high-tech imaging prior authorizations
Here's how to submit the required information to receive an authorization number.
- Recommended: Log in to the AIM website at www.providerportal.com 24 hours a day, 7 days a week.
- Requests may be approved in real time and authorization numbers provided immediately.
- If you do not have an AIM account, you must register first.
OR - Call AIM toll-free at 800 552-0020, Monday through Friday, 8 a.m. to 5 p.m. Eastern Time.
Add-on procedure requests
To request add-on procedures to an existing authorization, call AIM within 5 business days of service at 800 552-0020. Specify the existing authorization number. These requests can be made by either the servicing or ordering provider.
Urgent procedure requests
Ordering providers must call AIM within 5 business days of service at 800 552-0020 when you have already performed urgent procedures. You must specify that the services were urgent when you call.
Retroactive requests
Requests other than those for add-on or urgent procedures (see above) will not be accepted.
Change a previously authorized procedure
(Example: CT ordered, CTA needed) The ordering physician should call and obtain a new authorization number prior to the service being performed. Follow the procedure for requesting a new authorization.
More information about the prior authorization process
