![]() ![]() As technology improves, the cost and utilization of these services increase. Laboratory medicine is continuing to become increasingly complex. The cost of health care is rising for everyone and we have an obligation to ensure that our members receive the highest quality of care at the most affordable cost. Note that with this new program, certain lab procedures when performed in an office, outpatient or independent lab location will require prior authorization. January 1, 2016, we introduced a program that will improve the quality and reduce the cost of laboratory services our members receive. What Physicians Need to Know About Avalon Please check this page frequently for new information. Avalon is an independent company that provides benefit management services on behalf of BlueCross and BlueChoice ®. Review the specific procedures in the utilization matrix.īlueCross ® BlueShield ® of South Carolina is an independent licensee of the Blue Cross Blue Shield Association.Įffective January 1, 2016, BlueCross ® BlueShield ® of South Carolina and BlueChoice HealthPlan of South Carolina require Avalon Healthcare Solutions to precertify certain lab procedures when performed in an office, outpatient or independent lab location. Radiation Therapy Treatment Notification FormĮffective November 1, 2016, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan require precertification for nuclear cardiology services through National Imaging Associates (NIA). This precertification requirement is only applicable to BlueCross and BlueChoice Exchange members receiving nuclear cardiology services.Radiation Oncology Solutions Presentation.Radiation Oncology Claims Review Matrix.Radiation Oncology Frequently Asked Questions (FAQ).Here are National Imaging Associates' reference materials about this radiation oncology program: ![]() RadMD Pain Management Surgery Quick Start Guideīeginning January 1, 2015, some groups will require National Imaging Associates (NIA) precertification for radiation oncology services when performed and billed in an outpatient or office location.RadMD Pain Management Injection Quick Start Guide.MSK Spine Surgeries Frequently Asked Questions.MSK Quick Reference Guide for Order Physicians/Surgeons. ![]() MSK Interventional Pain Management Frequently Asked Questions.MSK Interventional Pain Management Checklist.MSK Group Prefixes Requiring NIA MSK Precertification.Here are NIA Magellan Healthcare Inc.’s reference materials about this musculoskeletal (MSK) care management program: We also require prior authorization for lumbar and cervical spine surgery in an inpatient and/or outpatient location. precertification for interventional pain management spine services when performed and billed in an outpatient or office location. View the Cardiac Services Checklist and Cardiac Services Tip Sheet to learn more about prior authorization requirements.īeginning May 1, 2016, some groups will require National Imaging Associates (NIA) Magellan Healthcare Inc. Refer to the BlueChoice ® Radiology Utilization Matrix for specific procedures that require authorization. RadMD, one of the services NIA provides, allows contracting health care providers to enter authorization requests via the internet. Those companies are solely responsible for the contents and privacy policies on their sites.) Please select "BlueChoice HealthPlan" followed by the study desired. You can also view their radiology policies. Visit RadMD, the secure webpage of National Imaging Associates (NIA). Musculoskeletal Care Management Program.Magellan manages precertification for advanced radiology, musculoskeletal care, radiation oncology and nuclear cardiology, as well as certain imaging services. ![]() NIA Magellan is an independent company that provides utilization management services on behalf of BlueChoice HealthPlan. Services Managed by NIA Magellan Healthcare Inc. Please use the Prior Authorization Request for Ancillary Services Form. You can also submit requests using the Prior Authorization for Services and Procedures Form.Īncillary Services - BlueChoice HealthPlan directly manages prior authorizations, claims and network management processes for ancillary services, including: Precertification and Referral Guide - Learn how to submit a referral or precertification request through My Insurance Manager SM and determine which services we can automatically authorize. The system is fast and easy to use and ensures accuracy. The Medical Form Resource Center (MFRC) is an online tool created to allow you to submit your precertification requests for some services electronically. ![]()
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