Provider Manuals > Radiology Prior Approval

Radiology Prior Approval

Information for Providers

• New York State Medicaid Program has implemented a radiology management program to ensure that beneficiaries receive the most clinically appropriate imaging studies. The program is applied to outpatient non-emergency advanced imaging procedures, for fee-for-service beneficiaries.
• Beneficiaries who are eligible for both Medicaid and Medicare (dual eligible) or beneficiaries who are enrolled in a managed care plan are not included.
• Consult™, administered by HealthHelp, is a consultative, educational program that improves quality and reduces the cost of care by providing expert peer consultation and the latest evidence-based medical criteria for diagnostic imaging. It provides access to consultations with subspecialists affiliated with academic radiology departments.
• Providers must be enrolled in New York State Medicaid Fee for Service
• Review Important Documents (on the right) for further information

Information for Ordering Providers

• If you are ordering a CT, CTA, MRI, MRA, Cardiac Nuclear, or PET procedure, you or your office staff are required to obtain an approval number through the Consult™ program. Requests will be reviewed against guidelines, and a prior approval number will be issued.
• If you also provide in-office radiology imaging, you are asked to confirm that Consult™ has processed and approved the procedure request before scheduling an appointment. This will ensure payment of the claims you submit for services.

Information for Radiology Providers

• If you are performing a CT, CTA, MRI, MRA, Cardiac Nuclear, or PET procedure, you must verify that an approval has been obtained before performing these diagnostic imaging services for New York Medicaid FFS beneficiaries. Approvals will be required for claims payment. Failure to obtain an approval number may delay or prevent payment of a claim.

HealthHelp Webinars

For more information about HealthHelp Webinars please send the following information to casimirm@healthhelp.com:

• Facility or practice name and NPI
• Address of practice
• Number of providers in the practice
• First and last name of the staff member who is the main point of contact
• Contact phone, fax and email