Services Requiring Pre-authorization

Search or browse by service type to see services requiring pre-authorization.

Please also check the QualChoice Coverage Policies if you do not find a specific procedure listed here.

These services require Pre-Authorization.Click to View Medical Policy
Ablation of Hepatic Lesions
Allergy Testing - some methods.
Automatic External Defibrillator (Life Vest)
Biofeedback *
Blood Pressure Monitoring - 24 Hour Ambulatory
Bone Density Testing members Women under 50 and Men under 70.
BRCA Testing
Cardiac Event Recorder, Insertable
Continuous Blood Sugar Monitoring
CT Imaging including CT Angiography
High Tech Imaging (MRI, CT, PET) Criteria - administered by NIA
Erectile Dysfunction Treatment
Excimer Laser Treatment
Genetic counseling and genetic testing (including chromosome analysis). *
Hypnotherapy
Laser Treatments *
Liver Neoplasms
Magnetic Resonance Imaging (MRI) all types including MRA.
High Tech Imaging (MRI, CT, PET) Criteria - administered by NIA
Mental Health & Substance Abuse Treatment
Negative Pressure Wound Treatment (Wound Vac)
Neuropsychological Testing
Nuclear Medicine - all imaging tests including SPECT.
High Tech Imaging (MRI, CT, PET) Criteria - administered by NIA
Obstetrical (OB) Ultrasound Examinations
Outpatient Hyperbaric Oxygen Treatment
P.E.T. Scan
High Tech Imaging (MRI, CT, PET) Criteria - administered by NIA
Prolonged EEG Monitoring
Psychological Testing
Urinary Incontinence Treatment
Vagus Nerve Stimulation

QualChoice Network Medical Providers: You will receive verbal approval when requesting pre-authorization. Please inform your patient at that time that the request has been approved. Thank you.

Pre-authorization is the decision to cover a planned medical procedure, prescription drug or medical device. Pre-authorization is not a promise of payment for care or services.

Items with an asterisk (*) may be reviewed after the service has been performed. All others must be approved before services are performed. The member must get pre-authorization for any services outside the network noted on their ID card.

Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

 
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