Scheduling Process to Align More with Pre-Cert Requirements

Premier Health will be modifying its scheduling process for certain imaging exams to better align the scheduled test date with the amount of time needed to complete the pre-certification process with insurance carriers.

As you are aware, to manage costs and to ensure appropriate use of testing, health insurance organizations have been increasing the frequency in which pre-certification is required. In addition, changes to payer policies have made it more difficult for health care providers to appeal denied services when pre-certification is not obtained. The result is that Premier Health has seen an increase in denials, resulting in frustration for patients, ordering physician offices, and radiologists, while limiting Premier Health's ability to collect payment on these services.

The changes being made will initially apply to MRI’s, CT’s and Nuclear Medicine (including PET) exams. In most instances, these tests will be scheduled three to five business days out unless a more urgent need is indicated. It is estimated that fewer than 20 percent of tests will be affected by this change. We recognize that certain tests require more timely scheduling. We will continue our current process for scheduling these tests based on physician orders.

In the event a test has been denied or is under review with insurance, Premier Health’s pre-certification department will contact the patient and the ordering physician’s office and apprise them of the situation.

We appreciate your support of these changes to better align the scheduling of tests with the anticipated time needed to complete the pre-certification process. 

Back to the October 2017 issue of Premier Pulse