Prior Authorization/Notification Information - Radiology Management Program

Radiology Management Program Prior Authorization

The Prior Authorization component of Highmark West Virginia's Radiology Management Program will require all physicians and clinical practitioners to obtain authorization when ordering selected outpatient, non-emergency, diagnostic imaging procedures for certain Highmark patients (This authorization requirement doesn't apply to emergency room or inpatient scans). Such tests include select CT scans, select MRI and MRA scans, PET scans and Myocardial Perfusion Testing.

Radiology Management Program Prior Notification

The Prior Notification component of Highmark West Virginia's Radiology Management Program requires all physicians and clinical practitioners to obtain prior notification when ordering stress echocardiography. (This authorization requirement doesn't apply to emergency room or inpatient scans).
Authorization numbers will be issued for procedures requiring prior authorization/notification and will be required to ensure appropriate reimbursement.

How to Request Prior Authorization/Notification

You can obtain prior authorizations for non-emergent, high-tech outpatient radiology services through NaviNet, our secure web-based provider portal. NaviNet is available to request and verify affected services, and check member eligibility, saving you the time and effort of faxing or making a phone call. You'll receive immediate approval, or notification for further review, if it's needed.

If your office is not already registered for NaviNet, we encourage you to visit navinet.secure.force.com to sign up.

Clinical Validation of Records (CVR)

Effective Oct. 3, 2016, Highmark has implemented a Clinical Validation of Records (CVR) process for all codes that are part of the Radiology Management Program. The CVR process will include the request and review of clinical information by NIA.

Additional Resources

 

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Last updated on 12/11/2018

 

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