The Banner Imaging order form is the document your referring physician completes and signs to authorize a diagnostic scan at a Banner Health imaging center in Arizona or Northern Colorado. It records who you are, who your insurance is with, which exam is being ordered, and the clinical reason for it. Once the form is filled out, it goes to Banner’s central scheduling team by fax at 480-610-7401 or through the provider portal at imagingportal.bannerhealth.com.1Banner Imaging. Banner Imaging Patient Portal Without a signed order, the imaging center cannot schedule or perform the scan.
What the Form Must Contain
The top of the form is patient and insurance information. Enter your legal name exactly as it appears on your government-issued ID, your date of birth, and current phone number and address. The insurance section needs the policy number, group number, and the carrier’s name and phone number. Copy these directly from your card. A single wrong digit in the policy number can cause the claim to be rejected before the imaging center even reviews it.
The provider section captures the ordering physician’s name, office address, phone and fax, and National Provider Identifier. The NPI is the 10-digit number assigned to every covered healthcare provider under federal rules and is required on billing and administrative transactions, so a missing or incorrect NPI will hold up the order.2Centers for Medicare & Medicaid Services. National Provider Identifier Standard
The clinical portion is completed by your provider. It has to specify the modality, the body part, whether the study is with contrast, without contrast, or both, and at least one ICD-10 diagnosis code with a short clinical history. The ICD-10 code is how the insurer decides whether the scan is medically necessary. A missing code, or one that doesn’t match the exam ordered, is the most common reason imaging orders get sent back for correction.
Finally, the order is not valid without the physician’s signature and the date it was signed. The signature is a legal attestation that the scan is medically necessary. If your appointment is happening well after the order was written, ask the provider whether a fresh order is needed; older signatures can be questioned by the facility or the insurer.
Priority: Routine, Urgent, or STAT
The form lets the provider mark how quickly the scan is needed. A STAT order covers conditions that threaten life or limb, and the imaging center aims to complete the study within roughly an hour of arrival. Urgent orders are for acute situations that are not immediately life-threatening but shouldn’t wait, and are typically performed within 48 hours to seven days. Routine outpatient orders carry no priority flag and are scheduled based on availability.
Safety Information the Form Triggers
Some exams require lab work or screening before the order can move forward. Knowing this in advance keeps the form from stalling.
MRI Screening
MRI uses a strong magnetic field, so metallic implants and devices can be dangerous inside the scanner. Before an MRI you’ll be screened for cardiac pacemakers and defibrillators, cochlear implants, cerebral aneurysm clips, drug infusion pumps, neurostimulation systems, bone-anchored hearing aids, metallic intraocular foreign bodies, and shrapnel or other retained metal. A history of welding without eye protection or of facial trauma involving metal may require an orbital X-ray before the MRI is cleared. If the safety status of a specific implant cannot be verified, the device is treated as unsafe and the scan will not proceed.3National Center for Biotechnology Information. Magnetic Resonance Imaging Contraindications
Kidney Function for IV Contrast
Iodinated contrast used in CT scans is cleared by the kidneys. Standard guidelines call for a current creatinine level or estimated glomerular filtration rate before contrast is given, with “current” generally meaning within one month for outpatients. Contrast is typically withheld when eGFR is below 30 or creatinine is above 2.4 mg/dL. If you have kidney disease, diabetes, or take metformin, expect the facility to request labs before scheduling a contrast study. Patients on chronic hemodialysis who produce no urine may still receive contrast, with dialysis to follow within 24 to 48 hours.4Department of Radiology – UW–Madison. Creatinine Guidelines for Iodinated IV Contrast
Pregnancy
For patients of childbearing age, the facility will ask about possible pregnancy before any study using ionizing radiation (CT, X-ray, fluoroscopy, nuclear medicine) or contrast agents. The American College of Radiology advises that the medical benefit outweigh the managed risks, and leaves specific screening policies to individual institutions.5American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation Tell your provider before the order is placed if pregnancy is possible so you can decide together whether to proceed, modify the study, or use ultrasound or MRI instead.
Prior Authorization Before Submission
Many insurance plans require prior authorization for advanced outpatient imaging, including CT, MRI, MRA, PET, and nuclear cardiology studies. Authorization is generally not required when the same scans are done in an emergency room, during an inpatient stay, or at urgent care. The ordering provider’s office usually handles the request, but confirm it has been approved before your appointment. Without authorization the insurer can deny the claim outright, and depending on your plan you may be on the hook for the full cost.
How to Submit the Form
Banner Imaging accepts completed order forms through three channels:
- Fax the signed form to central scheduling at 480-610-7401.
- Providers with access can submit electronically through imagingportal.bannerhealth.com. Portal support is available Monday through Friday, 8:00 a.m. to 4:30 p.m. MDT.1Banner Imaging. Banner Imaging Patient Portal
- Call central scheduling at 480-610-7400 with questions or to confirm the order was received.
Keep a copy of the signed form. If it was faxed, the transmission confirmation is your proof of delivery.
What Happens After Banner Receives the Form
Scheduling reviews the form for completeness: physician signature, ICD-10 code, exam details, and insurance information. Anything missing or unclear sends the order back to the provider’s office for clarification, which adds time. Portal requests are processed during standard business hours, Monday through Friday.1Banner Imaging. Banner Imaging Patient Portal
Once the order clears review, a scheduler calls you to set the date, time, and location, and to give pre-test instructions such as fasting requirements, what to wear, whether to take your regular medications, and when to arrive. If you haven’t heard from Banner within a few business days of submission, call 480-610-7400. Orders occasionally get lost in fax transmission or held up in review, and a quick call is the fastest way to find out.
If You’re Uninsured or Paying Cash
If you don’t have insurance or aren’t using it, Banner is required under the No Surprises Act to provide a Good Faith Estimate of the total expected cost before your scan. The estimate must include all reasonably anticipated charges: the facility fee, the radiologist’s professional fee, contrast materials, and related services.6Centers for Medicare & Medicaid Services. No Surprises Act Good Faith Estimate and Patient-Provider Dispute Resolution Requirements
Timing follows the appointment date. If the scan is scheduled at least 10 business days out, the estimate is due within three business days of scheduling. If the scan is booked at least three business days out, the estimate is due within one business day. You can also request an estimate before scheduling, and the facility has three business days to provide it.6Centers for Medicare & Medicaid Services. No Surprises Act Good Faith Estimate and Patient-Provider Dispute Resolution Requirements
If the final bill from any single provider or facility exceeds the Good Faith Estimate by $400 or more, you can dispute the charges through the federal patient-provider dispute resolution process. The dispute must be started within 120 calendar days of receiving the bill.6Centers for Medicare & Medicaid Services. No Surprises Act Good Faith Estimate and Patient-Provider Dispute Resolution Requirements