Service Grouping for CT and PET Scans Reminder

June 9, 2014

When entering a Prior Authorization (PA) into MIHMS, a “Service Group” can be selected instead of an exact code. This will cover such situations as when a member arrives for a radiology scan and a code change is needed because the PA was created for contrast, but the provider completing the services decides not to use contrast.

Selecting a service group:

To use the service group, select the group, but do not select the code in the box that appears just below the service group dropdown. This will create a PA for any of the codes listed, not one (1) for each.

Example of when to request a service group:

A provider requests a PA for a Chest CT with contrast and at the last minute (perhaps due to a lab value such as creatinine), it is decided that the member needs a CT without contrast. If the exact code is used in the PA, the provider will need to request a code change and the member’s scan may need to be postponed.

If you have questions, please contact Provider Services at: 1-866-690-5585 (TTY: 711) Monday – Friday 7:00 AM EST until 6:00 PM EST.