Beginning with dates of service November 1, 2008, for the BlueCare members in the West Grand Region and January 1, 2009, for BlueCare members in the East Grand Region, Volunteer State Health Plan will require prior authorization for select high tech imaging procedures performed in an outpatient setting. These services will not require prior authorization when a patient is receiving treatment in an emergency room or in an inpatient setting.
Procedures requiring prior authorization include, but are not limited to: CT, CTA, MRI, MRA, MR Spectroscopy, PET Scans, and Nuclear Cardiology. At this time, TennCareSelect and individuals who qualify as dually eligible for Medicare and Medicaid are not subject to this prior authorization requirement.
MedSolutions has created a toll-free phone number to be used exclusively by providers that request prior authorization for these services for Volunteer State Health Plan members. Please call 877-791-4101 when requesting prior authorization for these members.