Prior Authorization Requirements

1. CT scans - for dates of service prior to 5/1/11, preauthorization is required only for CT scans of the head, brain, heart and pelvis; after 5/1/11, ALL CT scans require prior authorization.
2. All MRIs and MRAs require prior authorization.
3. All PET scans require prior authorization.

Instructions for viewing the InterQual Advanced Imaging Criteria for prior authorization

1. Click on the study you are requesting in the InterQual Advanced Imaging Criteria Table below. You will need Adobe Reader to view the PDF files below. If you do not already have it installed, click here for the free download from Adobe.
2. This will take you to the criteria set for all indications for this study. Click on the indication for the study you are ordering for your patient.
3. This will take you to the specific criteria. For instance, if you are ordering an MRI of the brain to evaluate headaches, you can click directly onto the diagnosis of headaches and the criteria set #400 describes the necessary history or examination that is needed in order for SHP to make a determination.
4. If you can’t find the indication that applies to your patient, just fax the request with clinical information and your reasoning for ordering the study.
5. Some of the criteria have notes and references - just click on the reference number to go to those.
6. You can print out the criteria set for future reference or save the PDF file to your office desktop.

When submitting your requests you have three options

1. You can fax your request on an SHP authorization fax request form to 1-877-267-7900.
2. You can request approval through the SHP Online Web Portal by completing our simple authorization request form and either attach clinical information within the web portal request or fax the information to the Care Coordination Department at 1-800-338-4195.
3. You can call the Care Coordination Department at 1-800-765-3805 for any inquiries or questions.

Checking the status of your authorization

1. Allow two (2) business days from submission of your request and
2. You can go to the SHP Online Web Portal to look up the status of the authorization
3. You will also receive a faxed determination letter from the Care Coordination Department