Radiology Benefit Manager

providercontact5RBM Process

The RBM process enhances the quality of services delivered to patients and reduces unnecessary radiation associated with advanced diagnostic imaging.

Overview

CaretoCare2016For 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.

Requests can be submitted via phone, fax or through Care to Care’s Care Portal.

Authorizations are valid for 90 days from the date of the consultation.

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

Requesting Consultations

Consultation requests can be made to Care to Care via phone, fax or web:

Care to Care’s call center is open:  M-F 5am – 5pm PST.

RBM Fact Sheet

Quick Reference Guide 

How to Navigate a Pre-Certification