Preferred Provider Access System Frequently Asked Questions

• What is PPAS?
  The Preferred Provider Access System is a designation awarded to physicians having demonstrated high approval rates for prior authorization of cardiac imaging modalities using CareCore National evidence-based criteria.
• How can I learn about PPAS?
  Learn about PPAS.
• What is the advantage of being a PPAS provider?
  PPAS providers will not be required to submit supporting documentation for cases meeting necessity criteria during the online cardiology prior authorization process.
• How can I apply for PPAS?
  Begin the PPAS application process.
• Who can apply for PPAS designation?
  Board certified cardiolologists can apply for PPAS designation.
• Does PPAS apply for cases initiated by phone or fax?
  No, cases started by phone or fax will follow the standard prior authorization process that is currently followed to obtain a prior Authorization. Faxed supporting clinical documentation may be requested.
• What imaging modalities are covered under PPAS?
  Providers may receive a PPAS designation for the following modalities; nuclear stress test, echo stress test, echocardiography, cardiac CT/MRI/PET, and diagnostic left heart catheterization (DLHC).
• Is the PPAS designation modality specific?
  Yes, PPAS providers will be modality specific.
• What health plans are participating in the PPAS designation program and for what modalities?
  • Aetna NY/NJ, Oxford NY, and HealthNet NY/NJ/CT for nuclear stress test
  • HIP and Horizon BCBS for nuclear stress test, echo stress test, cardiac CT/MRI/PET scans, and DLHC.
  • HIP for echocardiography
• Will there be PPAS designation for group practices?
  Yes, for a group to be selected for PPAS designation, the group prior authorization approval rates will be used to determine eligibility.
• Will individuals from a group practice be eligible for the PPAS designation without the group PPAS designation?
  No.
• What is the attestation?
  The attestation is the final process for PPAS designation. All selected PPAS candidates will be mailed an attestation form. This form details the rules and regulation for PPAS participation. Signed forms must be returned to CareCore National prior to be awarded PPAS designation.
• When will applicants be selected for PPAS designation?
  Three (3) months of authorization data must be collected before a physician or group can be reviewed for PPAS designation.  CareCore National will begin collecting data for PPAS eligible providers on September 2, 2008.
• How will providers be notified about PPAS designation?
  All PPAS designees will receive a PPAS package by mail, which will include the attestation form. The attestation will need to be signed and returned in envelope included with the package.
• When will PPAS providers be able to exercise their PPAS privilege?
  As soon as the completed attestation has been received by CareCore National, PPAS privileges will be available.
• What is the audit and what does the audit process involve?
  The audit is a retrospective review of the patient information provided for cases approved during the online cardiology prior authorization process. PPAS providers will be required to provide this documentation upon request from CareCore National.
• Can providers lose PPAS designation?
  Yes, PPAS designation can be rescinded for failure to comply with any of the rules and regulations defined in the attestation form.