The Cardiology Prior Authorization program is designed and managed by cardiologists, to ensure requests for select diagnostic cardiology services meet evidence-based guidelines supported by the American College of Cardiology, American Heart Association and Heart Rhythm Society. The CCN Cardiology guidelines are viewable at http://www.carecorenational.com/page/cardiology-tools-and-criteria.aspx under “HealthPlus of Michigan”.
Impact(s) to Reimbursement:Claims will deny if prior authorization is not obtained through CCN, prior to services being rendered. Retroactive reviews will not be granted.
Outpatient Cardiology Services REQUIRING Prior Authorization:
Prior Authorization is NOT required for in-patient hospital, emergency room, observation unit and/or urgent care centers.
Product Line ParticipationCommercial HMO and PPO, Options, and Medicare Plus Advantage HMO, when HealthPlus is secondary to another commercial insurance.
Medicare Plus Advantage PPO is encouraged to obtain a Pre Visit Coverage Decision.
Product Line Exclusions
Medicare Supplemental, County Health Plans and children under the age of 18, are excluded from the program.
If you have questions related to the program, please call HealthPlus Customer Service at 800-332-9161 or contact your Provider Network Educator.
To Prior Authorize a Cardiology Procedure
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