Radiology Benefit Manager
RBM Process
The RBM process enhances the quality of services delivered to patients and reduces unnecessary radiation associated with advanced diagnostic imaging.
Overview
For the past several years, CenCal Health has been focusing on provider consultations and patient safety as a means to control for appropriate utilization of high-tech imaging. CenCal Health has selected Care to Care, a URAC accredited as our new partner and together we are improving our Radiology Benefit Management (RBM) program for high-tech imaging to enhance the quality of services delivered to patients and reduce unnecessary radiation associated with advanced diagnostic imaging.
Process
The ordering physician’s office must contact Care to Care to request an authorization prior to ordering a high-tech imaging service. Based on clinical information from the physician’s office, Care to Care will then make consultative determinations using the clinical guidelines published on their website.
Exceptions
Imaging studies performed in conjunction with emergency room services, inpatient hospitalization, urgent care centers, or intra-operative procedures are excluded from the high-tech imaging consultation requirement. Imaging studies for members who have other health care coverage are excluded from the consultation process requirement.
Applicable Services
This program applies to the following outpatient services:
- Positron Emission Tomography (PET)
- Magnetic Resonance Imaging (MRI)
- Magnetic Resonance Angiography (MRA)
- Computed Tomography (CT)
- Computed Tomography Angiography (CTA)
- Nuclear cardiology studies
Click here for a listing of CPT Codes that require Prior Authorization
Requesting Consultations
Consultation requests can be made to Care to Care via phone, fax or web: