PRE-AUTHORIZATION

We realize insurance authorization requirements change frequently and have created this tool to assist you when scheduling patients for radiology exams.

Some insurance companies will allow Inland Imaging to assist you in obtaining prior authorizations; other insurance companies will only allow the referring office to obtain prior authorization. We understand this can be confusing and believe this page will help in clarifying the prior authorization process.

Our preauthorization information page will help you with the contact information to obtain an authorization and/or directions on what we need to obtain the authorization for you.

Insurance authorization requirements are very fluid, if you find a discrepancy with our information or have suggestions for this site, please email us at priorauthorizations@inlandimaging.com. We will investigate and update our information based upon your feedback. We look at this page as a continuous work in progress between Inland Imaging and the medical community.

General Information: Chiropractors and dentists cannot refer any Medicare or Medicare Advantage Plan patient's for any radiology services.

Please note: This is not a complete list of insurances in which we participate.

A - G

AARP Medicare Complete

Exam Types:
CT, CTA, MRA, MRI, Nuclear Medicine, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AARP

AARP

1-888-866-8296
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Aetna

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Evicore Website
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Alaska Care

Exam Types:
MRI (Knee), MRI (Lumbar)
Referral & Authorization Requirements:
Some plans
Obtainable by Inland Imaging: No
Reviewing Agency:
Alaska Care

Alaska Care

Look on the back of the insurance card for number.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

AmeriBen

Exam Types:
CT, CTA, MRA, MRI
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: Yes
Reviewing Agency:
AmeriBen
Additional Information:

All plans are different. Each one needs to be called on.
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

American Postal Workers Union (APWU)

Exam Types:
CT, CTA, MRA, MRI, Nuclear Cardiology, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
APWU

APWU

1-800-582-1314 Option 4

Additional Information:

NOTE: APWU PLANS PROCESS THROUGH EVICORE (FKA MED SOLUTIONS)
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Amerigroup

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, Nuclear Cardiology, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Amerigroup)
Additional Information:

This is a Medicaid plan.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Anthem Blue Cross

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Regence/Asuris)
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Apple Health (MDW of WA)

Exam Types:
Bone Density, CT (Abdominal), CT (Cardiac), CT (Head), CT (Pelvis), MRI (Breast), MRI (Cervical), MRI (Coronal Stir), MRI (Head), MRI (Lumbar), MRI (Upper & Lower Extremities), PET Scans, SI Joint Injections
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Apple Health (MDW of WA)
Additional Information:

BONE DENSITY (CPT 77080 & 77081) Notify PA they need to assign an authorization number.
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

GAU: NOTIFY PRIOR AUTHORIZATION IF CONTACTED REGARDING A GAU PATIENT.
NOTE: WE WILL NEED TO VERIFY IF PATIENT IS APPLYING FOR GAU. THIS IS AN INTERIM PROCESS WHERE THEY ARE IN A PENDING DETERMINATION STATUS OF WHAT MEDICAID PLAN THEY WILL BE PLACED ON. REFERRING OFFICE WILL NEE TO FAX THE GAU LETTER WITH THE ORDER OR THE PATIENT WILL NEED TO BRING THE LETTER TO THEIR APPOINTMENT.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

ASURIS

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Regence/Asuris)
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Blue Cross - Commercial

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Premera/Lifewise)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.
NOTE: BCBS OUT OF STATE PLANS (EX: IRONWORKERS/ARKANSAS/FLORIDA/TENNESSEE/IDAHO/RHODE ISLAND) ALMOST ALWAYS REQUIRE AUTHORIZATION. OTHER BCBS PLANS DEPEND ON THE POLICY LIMITS TO DETERMINE IF A PRIOR AUTHORIZATION IS REQUIRED. ASK PATIENT TO CALL ON ALL EXAMS TO VERIFY.
NOTE: FEDERAL BCBS DOES NOT REQUIRE PRIOR AUTHORIZATION
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Blue Cross - Out of State

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: No
Reviewing Agency:
Blue Card
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.
NOTE: BCBS OUT OF STATE PLANS (EX: IRONWORKERS/ARKANSAS/FLORIDA/TENNESSEE/IDAHO/RHODE ISLAND) ALMOST ALWAYS REQUIRE AUTHORIZATION. OTHER BCBS PLANS DEPEND ON THE POLICY LIMITS TO DETERMINE IF A PRIOR AUTHORIZATION IS REQUIRED. ASK PATIENT TO CALL ON ALL EXAMS TO VERIFY.
NOTE: FEDERAL BCBS DOES NOT REQUIRE PRIOR AUTHORIZATION

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Blue Cross of Idaho

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: No
Reviewing Agency:
Blue Card
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.
NOTE: BCBS OUT OF STATE PLANS (EX: IRONWORKERS/ARKANSAS/FLORIDA/TENNESSEE/IDAHO/RHODE ISLAND) ALMOST ALWAYS REQUIRE AUTHORIZATION. OTHER BCBS PLANS DEPEND ON THE POLICY LIMITS TO DETERMINE IF A PRIOR AUTHORIZATION IS REQUIRED. ASK PATIENT TO CALL ON ALL EXAMS TO VERIFY.
NOTE: FEDERAL BCBS DOES NOT REQUIRE PRIOR AUTHORIZATION

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

CHPW (Medicaid)

Exam Types:
Bone Density, Mammograms (Screen), MRA, MRI
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
CHPW
Additional Information:

Screening Mammograms under the age of 40.
NOTE: Effective 2017 CTA’s and PET no longer require prior authorization.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

CHPW Med Advantage

Exam Types:
Bone Density, Mammograms (Screen), MRA, MRI
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
CHPW
Additional Information:

Screening Mammograms under the age of 40.
NOTE: Effective 2017 CTA’s and PET no longer require prior authorization.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

CIGNA

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, Nuclear Cardiology, PET Scans
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Evicore Website
Additional Information:

All plans are different. Each one needs to be called on.
NOTE: CIGNA PLANS PROCESS THROUGH EVICORE (FKA MED SOLUTIONS)

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Confluence Health

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Confluence Health
Additional Information:

NOTIFY PRIOR AUTHORIZATION ON PATIENTS WITH THIS INSURANCE SO WE CAN FOLLOW-UP WITH THE PLAN.
NOTE: THIS PLAN WAS FORMERLY KNOWN AS: MOLINA PRIMENET WVC

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Coordinated Care Corp

Exam Types:
Bone Density, CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Coordinated Care Corp
Additional Information:

This is a Medicaid plan.
1st & 2nd OB US does not need a Prior Authorization. *After 2nd OB US Prior Authorization is required.
***Referring office must start the authorization for this plan

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

First Choice

Exam Types:
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: Yes
Reviewing Agency:

Additional Information:

Need to know what FC Plan. PA will follow that plans requirements. (Ameriben, Trustmark, GEHA etc)
WILL NEED TO CALL ON INDIVIDUAL PLANS TO VERIFY PRIOR AUTHORIZATION REQUIRMENTS. WILL NEED TO KNOW THE FIRST CHOICE GROUP THE PATIENT HAS TO CHECK ON THE PLAN REQUIREMENTS. (EX: AMERIBEN, TRUSTMARK, STARMARK, GEHA, ETC…)
NOTE: WILL NEED TO USE INDIVIDUAL INSURANCE CARDS FOR CONTACT NUMBERS.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

GEHA

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Evicore Website
Additional Information:

If Medicare is primary and GEHA is a secondary, need PA for Medicare part A only. No PA needed if Medicare A&B primary.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Great West

Exam Types:
CT, CTA, MRA, MRI, Nuclear Cardiology, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Evicore Website
Additional Information:

+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Group Health (See Kaiser Permanente)

Exam Types:
Referral & Authorization Requirements:
Reviewing Agency:

Additional Information:

(See Kaiser Permanente)

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

H - M

HealthNet

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Med Solutions
Additional Information:

+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Humana Medicare

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Humana
Additional Information:

***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific
NOTE: Humana Veterans is only used when the VA hospital cannot accommodate a patient. The insurance company will do a conference call with the patient at the time of scheduling. After they have the date scheduled Humana will get the authorization. The referral and authorization will be faxed to scheduling.
NOTE: When contacted by Humana Veterans to schedule Mammograms, they will include the original referral and note that we are able to process additional views and Ultrasound if indicated

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Inland Empire Electrical Workers

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Medical Rehab Consultants
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Kaiser Permanente (FKA Group Health)

Exam Types:
Bone Density, CT, CTA, DAT Scan, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Group Health
Additional Information:

FLUORO GUIDANCE (77001 & 77002) - MYOCARDIAL IMAGING - THERAPEUTIC ENEMA - CINERADIOGRAPHY/VIDEORADIOGRAPHY - NON-INVASIVE VASCULAR (CPT 93922/93923/93924/93965) - SI INJECTIONS FOR MRI ARTHROGRAM HIP REQUIRE TWO AUTHORIZATION (CPT 73722 & INJ CPT 27093)
***Referring office must start the authorization for this plan

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Labor and Industry (Federal/OWCP)

Exam Types:
CT, MRI
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Labor & Industry
Additional Information:

NOTE: IME DOES NOT REQUIRE PRIOR AUTHORIZATION
NOTE: COHE (CENTER OF OCCUPATION HEALTH & EDUCATION) – WORKS WITH WASHINGTON STATE L&I. IF A DOCTOR TELLS YOU THAT THEY ARE A PROVIDER FOR COHE WE CAN SCHEDULE THE PATIENT AND NOTE THE ACCOUNT. COHE DOES NOT REQUIRE PRIOR AUTHORIZATION.
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Labor and Industry (Sedgewick)

Exam Types:
Referral & Authorization Requirements:
Some plans
Obtainable by Inland Imaging: No
Reviewing Agency:

Additional Information:

For pre-authorization, providers must fax the UR nurse at 1-888-345-3061.
NOTE: IME DOES NOT REQUIRE PRIOR AUTHORIZATION
NOTE: COHE (CENTER OF OCCUPATION HEALTH & EDUCATION) – WORKS WITH WASHINGTON STATE L&I. IF A DOCTOR TELLS YOU THAT THEY ARE A PROVIDER FOR COHE WE CAN SCHEDULE THE PATIENT AND NOTE THE ACCOUNT. COHE DOES NOT REQUIRE PRIOR AUTHORIZATION.
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Labor and Industry (Self Insured)

Exam Types:
Referral & Authorization Requirements:
Some plans
Obtainable by Inland Imaging: No
Reviewing Agency:
Claims Manager

Claims Manager

Contacts vary depending on the plan of the self-insured.

Additional Information:

NOTE: IME DOES NOT REQUIRE PRIOR AUTHORIZATION
NOTE: COHE (CENTER OF OCCUPATION HEALTH & EDUCATION) – WORKS WITH WASHINGTON STATE L&I. IF A DOCTOR TELLS YOU THAT THEY ARE A PROVIDER FOR COHE WE CAN SCHEDULE THE PATIENT AND NOTE THE ACCOUNT. COHE DOES NOT REQUIRE PRIOR AUTHORIZATION.
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Labor and Industry (WA State)

Exam Types:
CT (Head), Epidural & Nerve Blocks, Facet Injections, MRI (Head), MRI (Spine), MRI (Upper & Lower Extremities), SI Joint Injections
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Qualis Health
Additional Information:

NOTE: IME DOES NOT REQUIRE PRIOR AUTHORIZATION
NOTE: COHE (CENTER OF OCCUPATION HEALTH & EDUCATION) – WORKS WITH WASHINGTON STATE L&I. IF A DOCTOR TELLS YOU THAT THEY ARE A PROVIDER FOR COHE WE CAN SCHEDULE THE PATIENT AND NOTE THE ACCOUNT. COHE DOES NOT REQUIRE PRIOR AUTHORIZATION.
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

LIFEWISE

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Premera/Lifewise)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Medicaid of Washington

Exam Types:
CT (Abdominal), CT (Cardiac), CT (Head), CT (Pelvis), MRI (Breast), MRI (Cervical), MRI (Coronal Stir), MRI (Head), MRI (Lumbar), MRI (Upper & Lower Extremities)
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
Qualis Health
Additional Information:

Month-to-month eligibility.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

MODA/ODS

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (ODS)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Molina

Exam Types:
CT, CTA, MRA, MRI, PET Scans, Ultrasound Shoulder Lavage
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Molina
If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Molina MarketPlace

Exam Types:
CT, CTA, MRA, MRI, PET Scans, Ultrasound Shoulder Lavage
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Molina
Additional Information:

CT Colongraphy requires prior auth for Medicare Advantage & Marketplace only

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Molina Medicare Advantage

Exam Types:
CT, CTA, MRA, MRI, PET Scans, Ultrasound Shoulder Lavage
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:
Molina
Additional Information:

CT Colongraphy requires prior auth for Medicare Advantage & Marketplace only

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

N - S

OWCP (Federal L&I)

Exam Types:
CT, MRI
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
OWCP Voice Response
Additional Information:

NOTE: THIS PLAN IS DIFFICULT TO CONTACT AT NUMBER PROVIDED IF WE CAN GET AUTHORIZATION FROM REFERRING OFFICE IT WOULD BE HELPFUL
NOTE: IME DOES NOT REQUIRE PRIOR AUTHORIZATION
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Pacificare Oregon

Exam Types:
CT, MRI, PET Scans, SPECT Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
PACIFICARE

PACIFICARE

Call the phone number on the back of patient's card.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Pacificare Washington

Exam Types:
CT, MRI, PET Scans, SPECT Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
PACIFICARE

PACIFICARE

Call the phone number on the back of patient's card.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

PacificSource

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (PacificSource)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

PHCS

Exam Types:
Referral & Authorization Requirements:
Based on plan
Obtainable by Inland Imaging: No
Reviewing Agency:

Additional Information:

WILL NEED TO CALL ON INDIVIDUAL PLANS TO VERIFY PRIOR AUTHORIZATION REQUIRMENTS.
NOTE: WILL NEED TO USE INDIVIDUAL INSURANCE CARDS FOR CONTACT NUMBERS.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

PREMERA

Exam Types:
CT, CTA, DAT Scan, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Premera/Lifewise)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Premera Med Advantage

Exam Types:
CT, CTA, DAT Scan, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Premera/Lifewise)
Additional Information:

Doctor’s office has to start authorization

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Providence

Exam Types:
CT, CTA, Epidural & Nerve Blocks, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Providence)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Regence

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
AIM (Regence/Asuris)
Additional Information:

NOTE: DAT SCAN RQUIRED FOR PREMERA (CPT 78607 AND A9584) IS PROCESSED DIRECTLY THROUGH THE PLAN.
NOTE: PLANS ABOVE ARE TYPCIALLY PROCESSED THROUGH AIM. SOME PLANS MAY PROCESS DIRECTLY THROUGH THE PAYOR. OTHER PLANS SUCH AS NW LABORERS PROCESS THROUGH “CARE ALLIES” OR BLUE CARD PLANS MAY PROCESS THROUGH “EVICORE”.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

T - Z

TRICARE For Life

Exam Types:
Referral & Authorization Requirements:
No authorization required
Obtainable by Inland Imaging: Yes
Reviewing Agency:

Additional Information:

No pre-authorization for any exams.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

UHC Military

Exam Types:
CTA (Cardiac), CT (Colonoscopy), MRA, MRI (Abdominal), MRI (Breast), MRI (Cervical), MRI (Chest), MRI (Head), MRI (Hip), MRI (Lumbar), MRI (Pelvic), MRI (Thoracic), PET Scans, US Guided Procedures
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
UHC (United Healthcare Military)
Additional Information:

Active duty personnel. Pre-authorization required for all exams (EXTREMITIES DO NOT REQUIRE PRIOR AUTHORIZATION). First OB ultrasound does not require pre-authorization, but following OB ultrasounds do.

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

United Healthcare - Commercial Plan

Exam Types:
CT, CTA, MRA, MRI, Nuclear Medicine, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
UHC
Additional Information:

NOTE: UMR HAS PLANS UNDER UHC & FIRST CHOICE…FOR UHC THE REFERRING OFFICE WILL START THE AUTH
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

United Healthcare - Community Plan (Medicaid)

Exam Types:
CT, CTA, MRA, MRI, PET Scans
Referral & Authorization Requirements:
Pre-authorization required
Obtainable by Inland Imaging: No
Reviewing Agency:
UHC
Additional Information:

NOTE: UMR HAS PLANS UNDER UHC & FIRST CHOICE…FOR UHC THE REFERRING OFFICE WILL START THE AUTH
***Referring office must start the authorization for this Payor
+++This Payer is CPT Specific

If obtainable by Inland Imaging, you must provide the current H&P, the order, and a copy of the insurance card.

Inland Imaging is dedicated to providing outstanding service to our referring physicians by offering a wide range of support options. We offer IT support and integration as well as providing printed and digital materials to better assist in informing your patient about a procedure.

To schedule by phone, call 509.455.4455.

Order Online

To order online, a username and password is required. If you would like make orders online in the future, contact our Customer Service at 509.363.7799 to gain access to our web form.

Pre-Authorization Information

An updated list of prior authorization required by a variety of insurance companies.

Protocols

A categorized and searchable database of protocols for all modalities.