Highmark Blue Cross Blue Shield West Virginia, with the assistance of National Imaging Associates, Inc. (NIA), an affiliate of Magellan Health, Inc., has implemented a new imaging privileging process.
On this page you will find Highmark West Virginia's privileging requirements and online application instructions.
Process for Completing a Privileging Application
If you perform diagnostic imaging services and would like to apply to become a privileged provider, you must complete the online Highmark West Virginia Privileging Application.
You will need to contact NIA at 1-888-972-9642 or send an e-mail to RADPrivilege@Magellanhealth.com to obtain a login for the application. (Each diagnostic imaging location will require a separate application and login.) NIA will need the following information in order to assign a login.
- Provider name
- Address of diagnostic imaging location
- Tax identification number
Privileging Appeal Process
Highmark West Virginia requires that all network providers comply with the terms and conditions of their contracts and meet the applicable requirements for performing imaging services. Highmark West Virginia has established privileging requirements for providers who bill for imaging services in an outpatient setting.
Highmark West Virginia provides an appeal process for Highmark West Virginia Privileging Application denials. The following outlines the procedure for provider appeals of Highmark West Virginia Privileging Application denials:
- Written appeals must be requested in writing within 60 days of receiving a denial letter.
- Appeals should be submitted on letterhead that indicates the provider name, and includes the billing provider number and tax ID number of the provider/location that has been denied privileges.
- Documentation supporting the request for an exception to the Requirements or reason why the decision was incorrect should be included.
- Appeals and accompanying documentation should be faxed to 866-552-7589 (This fax number is intended for NIA Magellan application appeals only. Claim denial appeals should NOT be faxed to this number).
The Highmark West Virginia Privileging Appeal Hearing Panel will review all submitted documentation and issue a written decision that includes a statement of the basis for the decision, within 60 days of receipt of your appeal.
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Last updated on 12/17/2018