| Outpatient Services
Outpatient services are considered to be any/all of the following:
Outpatient testing such as CT, MRI, Endoscopy, Colonoscopy, etc.
Imaging studies.
Outpatient surgical procedures.
X-rays/ ultrasounds over $500. reimbursement
Home Health Care
Durable medical equipment
In-office procedures (even at the Primary Care Physicians office) that are over $500 reimbursement
The above services all require prior authorization. If a request is urgent, please indicate this on the authorization request. These requests will be processed on a same-day basis. However, urgent or stat requests are only to be used when any delay in service might result in placing the patient’s health in serious jeopardy or serious impairment of bodily functions. Services must be provided at the appropriate contracted facility for the health plan.
Please submit an authorization request form for these services, along with the documentation of medical necessity. If a patient is an in-patient, the hospital discharge planning department will supply this information. | 
