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.
- Radiology/Imaging Services Program Q&A
- Radiology/Imaging Services subject to PA/MND as part of this program
- Code Bundling Rules
- Code Pair Rules Bank
- Review our Standards for Diagnostic Radiology/Imaging Facilities/Freestanding-Office including Surgi-Centers and Diagnostic Dental - Radiographic Imaging
- Review our Diagnostic Imaging Privileging Policy to identify the accreditation required for practitioners and facilities to render and receive PA/MND approvals for radiology imaging services
- Contrast Agents and Radiopharmaceuticals
- Medical Information Requirements
- eviCore Online Forms & Resources
ANNOUNCEMENTS / UPDATES
- Maternal Fetal Medicine Evaluation Coding
- Clarification Notice: ER Preliminary Reads (Wet Reads)
- 72 Hour Rule
- Modifier 76
- Modifier 59
- Modifier 26
eviCore healthcare also manages Advanced Imaging Services provided to members enrolled in Horizon NJ Health plans and programs (including Medicaid Managed Care, NJ FamilyCare, Horizon NJ TotalCare (HMO D-SNP) and Managed Long Term Services & Supports (MLTSS). Visit the Horizon NJ Health eviCore healthcare webpage for information.
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.