Radiology Imaging/Nuclear Cardiology Services
Effective April 1, 2016, the Benefit Funds have partnered with eviCore healthcare (formerly CareCore National) to administer our Radiology Review program for prior authorization of elective outpatient MRA/MRI, CT/CTA and PET imaging studies, as well as nuclear cardiology services. The program was previously managed by Care to Care (CTC). One Call Care Management (formerly Medfocus) remains the preferred radiology provider network.
Search participating One Call Care Management radiology providers or call One Call Care Management at (800) 398-8999.
Outpatient High-Tech Radiology services require a prior authorization.
- Get the Radiology Privileging List, a list of covered radiology services that are payable based upon a provider’s specialty
- View the September 10, 2014 letter that was sent to 1199SEIU members regarding a patient privacy incident involving Emdeon (now Change Healthcare).
How to Request Prior Authorization for High-Tech Radiology and Nuclear Cardiology Services
- Online: Register for free at eviCore (formerly CareCore) and log into the “Ordering Provider Login.” You may be able to receive an immediate authorization if your patient meets the coverage criteria.
- By phone: Call eviCore toll-free at (888) 910-1199, Monday through Friday, from 7:00 am to 7:00 pm in all time zones.
- For urgent requests: If services are required in less than 48 hours due to medically urgent conditions, please call eviCore’s toll-free number at (888) 910-1199 for expedited authorization reviews. Be sure to tell the eviCore representative that the authorization is for medically urgent care.
Note: The initial authorization request will NOT be accepted via FAX by eviCore.
Note: eviCore will not accept post-service authorization requests.
If you have any questions about this program, please contact your Provider Representative, or call our Provider Relations Call Center at (646) 473-7160, Monday through Friday, from 8:00 am to 6:00 pm.
- eviCore Quick Reference Guide — A one-page guide on how to submit a prior authorization request, along with some contact information.
- Frequently Asked Questions (FAQs)
- Radiology Criteria — eviCore healthcare’s evidence-based clinical guidelines.
- Radiology and Cardiology Prior Authorization Codes
- Radiology and Cardiology Diagnostic Services CLAIMS STUDIO Procedure Codes
- Contrast Agents and Radiopharmaceuticals