Radiology Management Program

Clinical Guidelines
This link is designed to establish a pathway to clinical consensus on the use of a single or combination of Diagnostic Imaging examinations.

Frequently Asked Questions (FAQS): Facility Site Selection

Frequently Asked Questions (FAQs): General 
A document to help answer common questions regarding the Highmark Radiology Management Program

Prior Authorization
Advanced Imaging and Cardiology Services authorization requests for 2018 dates of service must be submitted to NIA before Dec. 31, 2018. Retro authorizations and/or appeals for dates of service in calendar year 2018 must be submitted to NIA no later than June 30, 2019. NIA medical policy guidelines for the applicable dates of service in 2018 will apply.

All requests for 2019 dates of service must be submitted to eviCore healthcare (eviCore).

Note: Highmark is partnering with eviCore for a new Advanced Imaging and Cardiology Services Program, effective Jan. 1, 2019. The eviCore program will replace the NIA Radiology Management 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.

To learn more about the new eviCore Advanced Imaging and Cardiology Services Program, please go to the Advanced Imaging and Cardiology Services Program page under Care Management Programs on the Provider Resource Center.

Privileging Appeal Process
Highmark has established a privileging requirement for providers seeking to bill for providing imaging services in the outpatient setting.

Privileging Application and Requirements (Effective 12/14/18, NIA no longer processes new privileging applications)
Highmark and National Imaging Associates, Inc. (NIA), an affiliate of Magellan Health, Inc., have implemented a new imaging privileging process. On this page you will find Highmark's privileging requirements and online application instructions.

Radiation Safety Awareness
To protect our members, and assist our network physicians in doing the same, Highmark is launching a Radiation Safety Awareness Project. This project will identify for you those members who have been exposed to a threshold amount of ionizing radiation.

Last updated on 2/7/2019

 

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