What gets approved on the first submission
Across payers, the studies that go through cleanly on the first submission share a few characteristics. The diagnosis code is specific. The submitted clinical history names the duration of symptoms, the conservative treatments tried, and the response. The clinical question is stated plainly — what decision will the result drive? When all three are present, denials drop substantially.
Documentation checklist
- Specific ICD-10 diagnosis code (not the catch-all when a specific code applies).
- Symptom duration and laterality.
- Failed conservative care: medication trials, physical therapy course, prior imaging.
- Red-flag review (presence or absence).
- Clinical question the study is intended to answer.
- Most recent relevant office note attached as supporting documentation.
Payer-specific notes (California outpatient imaging)
The notes below reflect patterns our prior authorisation team sees most often. Specific policies change frequently — always confirm against the payer's current medical necessity policy.
- Anthem Blue Cross / Blue Shield CA
- Most advanced imaging routed through AIM Specialty Health (now Carelon). Document conservative care explicitly.
- Aetna
- Advanced imaging often via eviCore. Specific symptom duration and failed conservative care are emphasised.
- Cigna
- Many advanced imaging studies via eviCore. Pre-service review for MRI, CT, and CTA.
- UnitedHealthcare
- Many advanced imaging studies via UHC / Optum. Prior auth via the UnitedHealthcare Provider Portal.
- Medicare (traditional fee-for-service)
- Most outpatient imaging does not require prior authorisation. Confirm LCD applies to the indication.
- Medicare Advantage
- Each plan is different — most follow commercial-style prior auth for advanced imaging.
- Medi-Cal managed care
- Plan-specific; many require TAR or plan-specific authorisation for MRI and CT.
- Workers' compensation
- Authorisation routed through the claims adjuster and Utilisation Review per California regulations.
When a study is denied
Most denials are correctable. The most common path forward is a peer-to-peer call with the payer's reviewing physician, supported by the documentation listed above. Our prior authorisation team coordinates these on request — submit through the provider portal or call our intake line and we will work the appeal in parallel with your office.
How Precise helps
Our team handles prior authorisation submissions for studies referred to our network, follows up with the payer on pending decisions, and notifies the referring office of approvals and denials. We do not, and cannot, replace the clinical documentation that supports medical necessity — that has to come from the chart.
Questions referring offices ask first.
Does Precise submit prior auth on our behalf?
Yes — we submit, follow up, and notify your office of the outcome for studies referred into our network. We rely on the clinical documentation from your chart.
What is the fastest way to get a denial overturned?
Peer-to-peer with the payer's reviewing physician, with the documentation checklist on this page in hand.
Educational reference for referring providers. Not a substitute for clinical judgement or the current official appropriateness criteria. References imaging modalities offered by Precise; modalities not in our network are out of scope.