Medical Precertification Frequently Asked Questions

• How do I search for the facility I wish to perform the scan?

  Using the NPI of the facility is the most efficient way to locate the facility. Other options include a name search or a tax id search. IMPORTANT: Only use one search field at a time.

• When I search for a facility I do not get the address I expected. Can you explain?

  Today the facility may have only one NPI/address on file with MO HealthNet, however, facilities are completing accuracy assessment questionnaires for each location at which they perform one of the listed codes.  Additional locations / addresses associated with the same provider NPI will be loaded as the provider fulfills the assessment requirements for each site.

• Do I need a prior authorization for a patient in observation care?

  No. While this was required in previous policy, we no longer require prior authorization for a patient in observation care.

• If a participant has Medicare Part B, do they need prior authorization for these services?

  No.

• What if I don’t know the NPI for the facility where I am referring the participant?

  You may want to check with the facilities where you frequently refer patients and get their NPI.  You may also search the NPI registry.

• When does the Accuracy Assessment start?

  NOW! Accuracy Assessment registration for each location is currently under way. Beginning October 1, 2010 any unregistered locations will not be able to obtain a prior authorization for services.

• What does the Accuracy Assessment mean to me?

  Hospitals – Hospitals should contact MSI (accuracymgmt@medsolutions.com or 800-457-2759) to register EACH of their locations at which any of the types of scans requiring a PA will be performed. Prior authorization must still be obtained for all outpatient elective MR, CT, PET, Cardiology, and Ultrasound studies.

  In-office imaging and free-standing imaging providers – Each location will need to be registered and evaluated for compliance with recognized standards for patient safety, equipment adequacy and staff training/certification. If you did not receive a letter for each location performing one of the listed modalities containing the user id and password, you will need to contact MedSolutions at 800-457-2759 or accuracymgmt@medsolutions.com.