Working with health care providers and care teams, Highmark is helping to implement nationally accepted, evidence-based guidelines. Often, these models only require some changes to the way most practitioners deliver care today. More important, they’re proven to add up to better patient outcomes and more affordable care.
To that end, Highmark is partnering with eviCore healthcare (eviCore) for a new Advanced Imaging and Cardiology Services Program, effective Jan. 1, 2019. This program incorporates a comprehensive, evidence-based clinical review including predictive intelligence, clinical decision support, and peer-to-peer discussions.
The eviCore program will replace the previously implemented National Imaging Associates (NIA) program. However, eviCore will oversee the same Highmark members and prior authorize largely the same set of advanced diagnostic imaging and cardiology services along with new additional services.
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 members, plus members of select self-insured (Administrative Services Only) groups.
Note: The Federal Employee Program is excluded from this program.
Learn More About the Advanced Imaging and Cardiology Services Program
You can access eviCore's Highmark implementation site for the most current information at https://www.evicore.com/provider/clinical-guidelines. There you'll find eviCore's evidence-based clinical guidelines, and other important resources and recent announcements.
Other options available to you for updates about the Advanced Imaging and Cardiology Services Program include the Plan Central page of NaviNet, Hot Topics messages on the Provider Resource Center, and future issues of Provider News.
Last updated on 2/18/2020