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 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
- Cardiac CT
- Cardiac MRI
- Cardiac PET
- Coronary Computerized Tomographic Angiography (CCTA)
- Diagnostic Heart Catheterization
- Echo Stress Testing
- Nuclear Stress Test
- Transthoracic Echocardiography
Prior Authorization is NOT required for in-patient hospital, emergency room, observation unit and/or urgent care centers.
Product Line Participation
Commercial HMO and PPO, Options, 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
To Prior Authorize a Cardiology Procedure