The Highmark Blue Shield Prior Authorization requirement for enumerated diagnostic imaging procedures will become effective April 1, 2006. The Prior Authorization Guide (Guide) is available on the Highmark Provider Resource Center Web site.
*Prior authorization will be required for those MRI, MRA, CT and PET procedures listed in the Guide. Prior authorization will not be required for in-patient and emergency procedures.
*Prior authorization applies to Select Blue Pos, Direct Blue, PPO Blue, Freedom Blue and EPO Blue; it does not apply to indemnity and Medicare supplemental process.
*Prior authorization will not prevent retrospective denial for lack of medical necessity.
*Prior authorization can be obtained via NaviNet or calling the toll free number: 1-866-731-2045 – Option 5.