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Preauthorization Requirements
Referring physicians must obtain prior authorization from CareCore National for the following radiology services:

  • PET Scans
  • CT Scans
  • MRI/MRA
  • Nuclear Cardiology

Follow this link to view the list of current CPT codes included in the radiology authorization program.

Conventional x-rays and ultrasound studies do not require preauthorization. In general, Excellus BCBS follows CareCore National criteria for radiology imaging. However, after an independent review of the evidence, our corporate medical policy committee has made limited modifications.

To Request or Check the Status of an Authorization
You can request preauthorization online or by fax:

  • Request or Check the Status Online
    (login required, you'll be taken to CareCoreNational.com) - If you have trouble accessing the CareCoreNational Web Portal please call the Excellus dedicated phone line at CareCoreNational at 866-889-8056 to request authorizations. Authorization requests can also be faxed to CareCore National at 866-466-6964.
  • Please note: Important changes to the CareCore Web
    • This is a temporary change to the authorization process as we work to develop and enhance the site selection process. We will continue to develop this function and your office will be notified when this work is complete.
      • Referring providers will not be required to select a rendering site at this time. This is for all methods of preauthorization requests including web transactions, faxes and phone calls to CCN.
      • Rendering providers At this time, "rendering site selection" information is not required to process your claim and is not needed on any preauthorization. Claims will not deny or process at a lower benefit level due to lack of preauthorization as long as there is an approved authorization on file for the CPT code you are billing and the date of service falls within the associated date range.
  • PET Fax Request Form(PDF)
  • MRI/MRA, CT/CTA & Nuclear Cardiology Fax Request Form(PDF)

Tips for Accessing the CareCore Web Site

For Physicians & Office Staff –
To protect against patient privacy, your Excellusbcbs.com Username was associated with a specific physician ID ("P010" number) when you registered. The CareCore Web site will identify you using that provider number.

  • If you are in a group practice, you can request preauthorizations for any physician in the group by selecting the appropriate physician name. When checking status on authorizations for a patient, all authorizations for the group will be displayed for that patient.
  • Both referring and servicing physicians and staff can now log in to the CareCore Web site:
    • Referring physicians and staff can request authorization, check the status of authorizations or verify if preauthorization is required.
    • Servicing physicians and staff can check the status of authorizations or verify if preauthorization is required.
  • For questions about using the CareCore Web site, please call CareCore directly at 1-800-918-8924 ext 10036. If you experience difficulty connecting from our Web site to CareCore, please call our Web Security Help Desk at 1-800-278-1247.

For Hospital Staff -
We are working to provide you with online access to CareCore in the coming weeks. In the meantime, you can call CareCore directly at 1-866-889-8056.

Program Information
View our Provider Reference Guide (PDF) for information about the CareCore National imaging management program. The guide contains contact information, urgent and emergent imaging process guidelines, directions on how to file an appeal , and other pertinent topics.  Follow the links below to learn about the Appeals Process:

 


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