Preauthorization Request Service

Larchmont Imaging is happy to introduce our Insurance Preauthorization Request service.

Many insurance providers ask Larchmont Imaging to obtain preauthorization (pre-preauth) forms on behalf of our patients that have been referred to us. To begin a preauthorization request, please fax the following information to Larchmont Imaging at (877) 211-9603.

  • Order/Referral/Prescription for the requested study
  • Completed Preauthorization Request Form and
  • Any applicable clinical notes to support the Preauthorization Request.

Larchmont will reach out to the correct Radiology Benefits Management Program (RBM) for the patient’s insurance carrier using the above information. Once the preauthorization is approved, we will contact the patient to schedule the study. If the preauthorization is denied or pending, we will notify you immediately so you can provide additional information or appeal the denial with the insurance carrier.

Unfortunately, Larchmont Imaging cannot obtain preauthorization for No-Fault (MVA), Workers Compensation, or non-participating insurance carriers.

If you have any questions or concerns regarding Larchmont’s precertification services, reach out to our Preauthorization Coordinator at (609) 261-4500 ext 1997.

Please click here to check our Insurance Participation List.

Preauthorization Request Forms