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.
In addition to this site and the eviCore webpage, you can also find any updates about the Advanced Imaging and Cardiology Services Program on the Plan Central page of NaviNet and future issues of Provider News.