Precertification for Diagnostic Imaging Effective July 1, 2008

As stated in the Network Facility Contract, the penalty for failing to obtain precertification for certain diagnostic imaging services has been implemented for charges incurred on or after July 1. Click here to view a list of the imaging services with CPT codes that require precertification.

If precertification is not met before services are rendered, providers will be charged a 10% payment penalty for late notification. Additionally, if medical necessity guidelines are not met, the service will not be covered by HealthChoice.

Precertification processes are the same as the current processes that are performed for HealthChoice by Fiserv Health Care Management.