The State Health Plan has a new system for preauthorizing CT, MRI, MRA and PET scans.
South Carolina network physicians, radiology (imaging) centers and outpatient hospital radiology centers will be responsible for requesting advanced radiology preauthorization from National Imaging Associates (NIA). On behalf of BlueCross, NIA handles preauthorization for certain imaging services. NIA is an independent company.
If a subscriber or a covered family member is scheduled to receive a CT, MRI, MRA or PET scan from an out-of-network provider in South Carolina, it is the subscriber's responsibility to make sure the provider calls for preauthorization. A subscriber can begin the process by calling NIA at 866-500-7664. The subscriber should be able to give NIA the name and phone number of the imaging center or the physician who will provide the radiology service.
NIA will make a decision about non-emergency preauthorization requests within two business days of receiving the request from the provider. If the situation is urgent, NIA will make a decision within one business day of receiving the request from the provider. The process may take longer, however, if NIA needs additional clinical information.
Subscribers can check the status of preauthorization requests online through My Health Toolkit.
If a South Carolina network physician or radiology center does not request preauthorization, BlueCross will not pay the provider. The provider cannot bill the subscriber for the service.
If a subscriber or a covered family member receives advanced radiology services from an out-of-network provider in South Carolina or from any provider outside South Carolina without preauthorization, BlueCross will not pay the provider. The subscriber will be responsible for the entire bill.