Please refer to the section below for answers to some of the most commonly asked questions about the 1199SEIU Benefit Fund’s radiology program.

Still have questions? Email Providers@1199Funds.org or call our Provider Hotline at (646) 473-7160.

What is changing on January 1, 2011?

Do imaging services provided in a hospital inpatient unit, observation unit or emergency department setting requires prior authorization?

Which providers are impacted by the program?

What information is required for a prior authorization?

What should the ordering physician do if a case is urgent?

How long will the non-urgent prior authorization process take?

How long is an approved authorization number valid for?

What is the prior authorization telephone number and fax number?

What is changing on January 1, 2011?
The 1199SEIU Benefit Funds have entered into an agreement with Care to Care (CtC), a radiology benefit management company, to administer the 1199SEIU Benefit Funds’ Radiology Review program for prior authorization of elective outpatient MRA/MRI, CT/CTA and PET imaging studies. MedFocus Radiology will no longer administer the program; however, MedFocus will continue to process prior authorization requests through the end of the year. MedFocus will remain the preferred radiology provider network.

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Do imaging services provided in a hospital inpatient unit, observation unit or emergency department setting requires prior authorization?
No, the prior authorization requirement only applies to outpatient, non-emergent diagnostic advanced imaging studies.

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Which providers are impacted by the program?

• All freestanding diagnostic imaging facilities, hospital outpatient diagnostic facilities and any physician office providing MRI/MRA, CT/CTA and PET studies.
• All providers who order these studies will be required to obtain authorization before any of these services are rendered in an elective outpatient setting.
• All providers who render these services should verify with the 1199SEIU Benefit Funds’ Radiology Review program that a prior authorization has been obtained.

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What information is required for a prior authorization?
a. Patient’s name, date of birth and member ID number.
b.Ordering physician’s information (name, provider number, telephone number and fax number)
c. Rendering provider’s name (facility name, telephone number and fax number)
d. Requested tests (CPT code or description)
e. The clinical indications for the study, including:

• Working diagnosis, if available
• Signs and symptoms
• Results of relevant tests, relevant medications or other therapies, and results thereof

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What should the ordering physician do if a case is urgent?
You may initiate a request for an urgent review by telephoning 1199SEIU Benefit Funds’ Radiology Review program at (888) 910-1199 and clearly advising the intake specialist that the case is urgent. If you have made your request by fax, be sure to write “URGENT” on the request. A decision will be rendered within three hours of receipt. If a patient requires an urgent test after regular business hours, or on a weekend or holiday, the ordering provider will need to notify 1199SEIU Benefit Funds’ Radiology Review within two business days of the service.

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How long will the non-urgent prior authorization process take?

• By phone: If all necessary information is available at the time of the telephone call and the request meets criteria, approval can be made, on average, within 10 minutes.
• By fax: Determinations will be turned around within 24 hours of receipt of all necessary information.

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How long is an approved authorization number valid for?
An approved authorization number is valid for 60 days from the date the approval was issued.

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What is the prior authorization telephone number and fax number?

• Telephone number: (888) 910-1199
• Fax number: (877) 601-1199 (Please click here to obtain a copy of the Radiology Review Prior Authorization Request Form.)

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