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Radiology Authorization
Bravo: Contact NIA at 1-800-642-2804 for all procedures
requiring authorization
Pennsylvania
Senior Partners: Contact 215-606-6336
Mid-Atlantic & Texas
Contact: 1-888-454-0013
All Regions
Requests may be faxed to: 1-866-464-0707
Transportation
Benefits vary according to plan. See Quick Reference Guide and Benefit Grid for details.
Vision
Pennsylvania
Contact Davis Vision : 1-800-584-3140
Texas
Contact OptiCare : 1-866-258-4102
Mid-Atlantic
Use Advantica Network – Contact Bravo Health for Customer
Service
PRIOR AUTHORIZATION RULES BY PLACE OF SERVICE
The following tables list outlines the Bravo Health authorization procedures by place of service. Services
listed in the tables require authorization as noted.
In Office (Place of Service 11,32,33)
DURABLE MEDICAL EQUIPMENT
Diabetic Shoes
Diabetic Supplies (initial set up only)
DME Purchase (All Medicare Approved) >$200 Per Line
Item
All Prosthetics except mastectomy bras, colostomy
supplies, indwelling Foley catheters
Rentals (All)
Repairs & Maintenance (All)
EDUCATION
Diabetic Education Training (Except Senior Partners)
Dialysis Self Training
Nutritional Education Classes (97802-97804) Diabetes and
Renal
LABORATORY
Labs (ALL) except these labs performed in Physician's
Office:
81000, 81002, 81003, 81007, 81025, 82010, 82270, 82272,
82570, 82947, 82962, 83026, 83036, 83721, 84478, 84520,
84703, 85013, 85014, 85108, 85610, 87449, 87804, 87880
Providers will be reimbursed for the lab draw (36415) for all
other labs tests not listed above.
