Prior Authorizations & Referrals

• Referral & Prior Authorization Request Form You can save this editable form to your desktop
• Speedy Recovery Program Authorization Form Note: This form is only to be used by participating orthopedic surgeons who have already obtained authorization approval
• Referral & Authorization Guide

RadConsult Program for High Tech Imaging, Radiation Therapy & Cardiac Catheterization Procedures

Effective August 1, 2011 PUP will begin using RadConsult™ to authorize radiation therapy and diagnostic cardiac imaging procedures, including cardiac catheterizations (2D3D conformal radiation, IMRT, brachytherapy, stereotactic radiation therapy and proton‐beam procedures). These procedures have been added to the current ordering program for CT, CTA, MRI, MRA, Cardiac Nuclear and PET procedures.

RadConsult, a radiology-centered program, provides real-time decision support for providers considering CT, CTA, MRI, MRA, PET and Cardiac Nuclear Medicine scans as part of a diagnostic work-up. The consult process involves collecting relevant clinical information from the ordering provider’s office, reviewing this information alongside current evidence-based guidelines, and, if necessary, providing provider-to-physician consultation for education on test appropriateness and member safety. The program follows URAC guidelines for utilization management.

• RadConsult FAQ
• Providing Evidence-Based Ordering Expertise
• Clinical Information Requirements
• Step-by-Step Instructions
• Procedure Code List Updated 08/2011
• High Tech Imaging Procedure Request Form