January 2020 Update: Radiology/Imaging Services Program and Cardiology Imaging Program
Horizon BCBSNJ will implement changes to the services included as part of our Radiology/Imaging Services Program and our Cardiology Imaging Program, both administered by eviCore healthcare (eviCore).
eviCore will conduct Prior Authorization/Medical Necessity Determination (PA/MND) reviews of the additional Nuclear Medicine, Nuclear Cardiac Imaging and Echocardiogram services represented by the recently approved procedure codes below when rendered on or after January 1, 2020.
Effective for services to be provided January 1, 2020, and after, eviCore will no longer conduct PA/MND of the services represented by the following procedure codes as part of these programs.
Review the complete list of services that require PA/MND review as part of these programs.
For more information about these and other eviCore programs, visit HorizonBlue.com/evicore. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.
CPT® is a registered trademark of the American Medical Association.
To submit a PA/MND request to eviCore (or to validate that a PA/MND was requested and/or approved) please:
- Visit eviCore.com or
- Call 1-866-496-6200, between 7 a.m. and 7 p.m., Eastern Time
Review the guidelines eviCore uses to conduct PA/MND reviews as part of this program.