Frequently Asked Questions
about the Fund's Radiology Program
The 1199SEIU Benefit Fund implemented new radiology requirements effective October 1, 2007 to ensure that 1199SEIU patients are receiving the tests they need in the most appropriate setting. Please refer to the questions below for answers to some of the most commonly asked questions about this program.
Still have questions? Email providers@1199Funds.org or call our Provider Hotline at (646) 473-7160.
What radiology procedures need to be pre-authorized after October 1? After October 1, 2007, you will need to request prior approval for MRIs, MRAs, PET scans and CAT scans by calling MedFocus at (888) 910-1199.
back to top Who is responsible for requesting prior approval for MRIs, MRAs, CAT Scans and PET Scans? The referring physician needs to call Medfocus at (888) 910-1199 to request an approval and must provide information regarding the patient's diagnosis and the body part for the examination being requested.
back to top Is there an expiration date for a prior authorization? Yes. The prior authorization for the benefit determination is valid for 90 days from the date on the approval letter.
back to top What is the Fund's radiology privileging program? The Fund's privileging program ensures that credentialed providers are providing the appropriate radiology tests. To be reimbursed for radiology services to 1199SEIU patients, your specialty must be included on the Fund's Privileging Specialty List.
back to top What if my specialty is not listed on the Privileging Specialty List? If your specialty is not listed on the Privileging Guide, you will not be reimbursed for any diagnostic radiology services in the 70000 cpt code series. Please refer your 1199SEIU patient to a radiologist or provider who is credentialed in one of these specialties. Click
here to review the Privileging Guide.
back to top Can any specialties provide all radiology services? Only Radiology specialties can provide all radiology services.
back to top If I have a dual specialty and one specialty is listed on the Privileging Guide and the other is not, can I provide radiology services under the approved specialty? If you have two specialties, please make sure the Benefit Fund has credentialed and listed you under both specialties. Your claims will be processed based on the specialty(ies) the Fund has credentialed you for.
back to top What will happen if I submit a claim for a radiology code that is not indicated for my specialty? The claim will be denied and you may not balance bill members as outlined in your Provider Agreement.
back to top Where should I refer my 1199SEIU patients if they need additional radiology services? Please refer your patients to a MedFocus radiology provider. You can find a list of participating radiologists here.
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