Lab & Radiology
EPO Provider's Offices: Lab and plain film x-rays can be provided in your office without Plan approval.
Plus Provider's Offices: Lab and plain film x-rays can be provided in your office without Plan approval; however, because there is a higher out-of-pocket expense associated with this benefit, it will be up to the member to elect to have ancillary services provided in your office or have you provide them with an order to take to an EPO Network lab/radiology facility at the EPO benefit tier.
If you are unable to provide lab services or x-rays in your office, or if the patient requires more advanced radiology services, you can refer your patients to an EPO Network (PDF) provider for care.
Lab services and plain film x-rays do not need prior plan approval; therefore, you can provide your patients with a signed order that includes a valid diagnosis to take to an EPO Network provider for services.
Advanced Radiology - procedures require prior plan approval. Please submit your precertification request to Kern Legacy. All authorizations will be directed to EPO Network providers unless the member contacts the plan to elect a Plus Network provider.