PRIOR AUTHORIZATION/NOTIFICATION INFORMATION - RADIOLOGY MANAGEMENT PROGRAM

Radiology Management Program Prior Authorization

The prior authorization component of Highmark Delaware's Radiology Management Program will require all physicians and clinical practitioners to obtain authorizations from National Imaging Associates, Inc. (NIA) when ordering select non-emergent, high-tech outpatient radiology services for Highmark Delaware members. These tests include select CT/CTA, CCTA, select MRI/MRA, and Pet scans.

Authorization numbers will be issued for procedures that require authorization and these numbers will be required to ensure appropriate reimbursement.

There are two reference guides available – one for ordering providers and one for imaging providers. It is the ordering physician's responsibility to obtain a prior authorization. Please review these materials and be prepared to contact NIA before ordering certain diagnostic procedures.

How to Request Prior Authorization/Notification

You can obtain prior authorizations for non-emergent, high-tech outpatient radiology services through NaviNet, our secure web-based provider portal. NaviNet is available to request and verify affected services, and check member eligibility, saving you the time and effort of faxing or making a phone call. You'll receive immediate approval, or notification for further review, if it's needed.

If your office is not already registered for NaviNet, we encourage you to visit navinet.secure.force.com to sign up.

If necessary, you may able request authorizations by contacting NIA via telephone at the toll-free number listed in the reference guides.

Clinical Validation of Records (CVR)

Effective Oct. 3, 2016, Highmark has implemented a Clinical Validation of Records (CVR) process for all codes that are part of the Radiology Management Program. The CVR process will include the request and review of clinical information by NIA.

Additional Resources

Back to Radiology Management Home Page

Last updated on 12/11/2018

 

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