---
title: Radiology Insurance Pre-Certification Form Template | Paperform
description: Professional radiology pre-authorization form for imaging centers. Collect patient information, referring physician details, insurance data, and medical necessity documentation efficiently.
url: "https://paperform.co/templates/radiology-insurance-pre-certification-form"
type: static
generatedAt: "2026-03-28T00:44:58.450Z"
---

[← Back to free form templates](/templates/)    ![Radiology Insurance Pre-Certification Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/radiology-insurance-pre-certification-form.png)
    [Preview](https://_preview.paperform.co/ai-template/radiology-insurance-pre-certification-form) [Use this template for free](/create?ai-template=radiology-insurance-pre-certification-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Radiologist](/templates/role/radiologist/)     About this free form template
### Simplify Radiology Pre-Certification with Paperform

Getting insurance pre-authorization for imaging procedures shouldn't involve mountains of paperwork and endless phone calls. This **Radiology Insurance Pre-Certification Form** template helps imaging centers, radiology departments, and diagnostic facilities collect all the information needed for insurance pre-certification in one clean, professional submission.

#### Built for Healthcare Workflows

This template is designed specifically for radiology practices that need to gather complete pre-certification documentation before scheduling imaging procedures. Whether you're processing CT scans, MRIs, ultrasounds, or other diagnostic imaging, this form ensures you capture patient demographics, insurance details, referring physician information, and medical necessity justification in a single workflow.

#### What Makes This Form Essential

Pre-certification requirements vary by payer, but the core information remains consistent. This template collects everything your billing team needs to submit authorization requests efficiently: CPT codes, clinical indications, prior treatment history, and supporting documentation. By standardizing your intake process, you reduce claim denials, minimize administrative back-and-forth, and get patients scheduled faster.

#### Automate Your Authorization Workflow with Stepper

Connect this form to [Stepper](https://stepper.io) to automatically route submissions to your billing team, notify referring physicians of authorization status, or integrate with your RIS and billing systems. You can trigger automated follow-ups when additional documentation is needed, track authorization turnaround times, and keep your entire team synchronized without manual data entry.

#### Professional, Secure, and Compliant

Paperform is SOC 2 Type II compliant and trusted by healthcare providers worldwide. This form template integrates seamlessly with your existing practice management systems through native integrations, webhooks, and Stepper workflows. With conditional logic built in, the form adapts based on the type of imaging requested, ensuring you only collect relevant information for each procedure.

Perfect for imaging centers, hospital radiology departments, outpatient diagnostic facilities, and mobile imaging services looking to streamline their pre-authorization process and improve claim approval rates.
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