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Advanced Imaging and Cardiology Services Program

Highmark has partnered with eviCore healthcare (eviCore) for the Advanced Imaging and Cardiology Services Program. This program incorporates a comprehensive, evidence-based clinical review including predictive intelligence, clinical decision support, and peer-to-peer discussions.

eviCore will manage the prior authorizations for advanced imaging and cardiology services for Highmark's fully insured Commercial, Children's Health Insurance Program (CHIP) of Pennsylvania, Medicare Advantage, and Affordable Care Act (ACA) members, plus members of select self-insured (Administrative Services Only) groups.

Effective August 1, 2021, the program will expand to include out-of-area (OOA) and out-of-network (OON) cardiology and radiology services.

Note: The Federal Employee Program is excluded from this program.

Learn More About the Advanced Imaging and Cardiology Services Program

eviCore has a dedicated webpage for Highmark providers to conveniently access evidence-based clinical guidelines, the current CPT code list, important resources and recent announcements. We encourage you to visit their site to ensure that you have the most current information.

Reference Materials

In addition to this site and the eviCore webpage, you can also find any updates about the Advanced Imaging and Cardiology Services Program in the provider portal(s) and future issues of Provider News.

Last updated on 5/14/2024 11:51:01 AM

 

eviCore healthcare is an independent company that does not provide Highmark products or services and is solely responsible for the products and services described here.
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The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.

All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.