- (1) Prior authorization is required for certain radiology codes. The performing provider (facility) or the referring/ordering provider may request prior authorization. Prior authorization requests must be made prior to the test being performed. In the event of an urgent situation (when the prior authorization cannot be obtained before the test is performed), a PA may be requested within 14 days from the date of service. The case must then meet the “urgent” criteria before it will be considered for review. Providers are allowed 30 days from the date of service to submit a request to change or add a code to an approved case.
- (2) If a request is denied, written notice will be sent to the provider and the recipient indicating the reason for denial. Information giving them their right to appeal is also included in this notice.
- (3) For further information regarding prior authorization for radiology procedures refer to Chapter 22 (Independent Radiology) of the Alabama Medicaid Provider Billing Manual.
Author: Teresa Thomas, Program Manager, Lab and X-Ray Services
Statutory Authority: State Plan 3.1-A; Title XIX, Social Security Act; 42 C.F.R. Section 440.30.
History: New Rule: Filed February 11, 2010; effective March 18, 2010.