Horizon BCBSNJ is partnered with eviCore healthcare to manage Advanced Imaging Services for our members through Prior Authorizations/Medical Necessity Determinations (PA/MND) with physicians. eviCore healthcare helps to ensure our members receive appropriate radiology/imaging services, provides clinical consultation to our participating healthcare professionals and assists in the scheduling of radiology/imaging services. The Advanced Imaging Services included in this program are CT/CTA, MRI/MRA, PET and Nuclear Medicine studies (including Nuclear Cardiology).
Please note that eligibility and participation may vary based on line of business therefore, all providers should check eligibility and benefits prior to performing any services related to this program. In addition, actual benefit determinations cannot be made until a claim is received and is subject to the provisions of the patient’s present contract including any applicable deductible, coinsurance and/or coordination of benefits. Payment is dependent on the patient being an eligible Horizon BCBSNJ member at the time the services are rendered. Authorizations will be affected should the claim submitted differ from the information provided at the time of a request.
Billing / Coding
- 2018 Radiology/Imaging Codes Requiring Prior Authorization
- Code Bundling Rules
- Contrast Agents and Radiopharmaceuticals
- Diagnostic Imaging Privileging Policy
- Radiology/Cardiology Imaging Program Rules Bank
- Medical Information Requirements
- eviCore Online Forms & Resources
Access our online Medical Policy Manual to review our Standards for Diagnostic Radiology/Imaging Facilities/Freestanding-Office including Surgi-Centers and Diagnostic Dental - Radiographic Imaging