Program Updates: Radiology/Imaging Services 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 as noted below. Both of these programs are administered by eviCore healthcare (eviCore).
eviCore will conduct Prior Authorization/Medical Necessity Determination (PA/MND) reviews of the services represented by the recently approved procedure codes below when rendered on or after August 15, 2021.
Additionally, eviCore will conduct PA/MND reviews of the services represented by the procedure codes below when rendered on or after September 1, 2021.
Review the complete list of services that require PA/MND review as part of these programs.
For more information about this 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, weekdays, 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.
eviCore healthcare is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the provision of Prior Authorization and/or Medical Necessity Review (PA/MND) of certain nonemergency radiology services.