New Imaging Management Solution Frequently Asked Questions
|
|
- Scot McBride
- 7 years ago
- Views:
Transcription
1 New Imaging Management Solution Frequently Asked Questions Beginning July 1, 2014, HealthKeepers, Inc. will require prospective clinical case review (prior authorization) for outpatient, nonemergent imaging for our members enrolled in Anthem HealthKeepers Medicare-Medicaid Plan (MMP) to be obtained through AIM Specialty Health (AIM). Anthem HealthKeepers MMP is a Commonwealth Coordinated Care plan. The following services are included in the program: Computed tomography (CT/CTA) scans, including cardiac Magnetic resonance (MRI/MRA), including cardiac Positron emission tomography (PET) scans, including cardiac Nuclear cardiology This document provides information on the new requirement to help you answer questions from providers. 1. What is AIM Specialty Health? AIM is a leading specialty benefits management company with more than 20 years of experience and a growing presence in radiology, cardiology, oncology, sleep medicine and specialty drug management. AIM s mission is to make health care services more clinically appropriate and affordable, as well as safer. As such, AIM promotes the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. 2. Why is HealthKeepers, Inc. focusing on diagnostic imaging? Diagnostic imaging is one of the most important clinical tools available to providers and patients. However, a growing number of studies have shown that a high proportion of imaging tests performed are not clinically appropriate. At an average cost per test of $500 to $900, the costs of inappropriate imaging are staggering. Cardiovascular imaging, in particular, represents a full third of the several billion medical imaging examinations performed worldwide on an annual basis. Yet several studies have indicated that up to 15% of cardiac imaging exams are inappropriate based on Appropriate Use Criteria (AUC) issued by the American College of Cardiology (ACC). 3. When will this program begin? Beginning July 1, 2014, AIM s website, ProviderPortal SM, and call center will be available for submission of order requests for imaging services occurring on or after July 1, How does a provider office staff member obtain an order number from AIM? There are two ways to obtain an order number for diagnostic imaging services: Providers may contact AIM online via AIM s ProviderPortal. They will need to log in as a registered user or register to access the portal. Call toll-free: Hours of operation are Monday through Friday, 8:00 a.m. 8:00 p.m. Eastern time. HealthKeepers, Inc. is a health plan that contracts with both Medicare and the Virginia Department of Medical Assistance Services to provide benefits of both programs to enrollees. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. AVAPEC /01/2014
2 5. How does the program work? Anthem HealthKeepers MMP Page 2 of 6 Ordering provider offices submit requests through ProviderPortal, AIM s interactive website, or through the AIM call center. Web users or callers will be guided through an interview where member and ordering provider s information, diagnosis, symptoms, exam type and treatment/clinical history will be requested. If the information provided meets AIM s clinical criteria and is consistent with HealthKeepers, Inc. s medical policy, the web user/caller will be guided to select an imaging provider where the imaging study will be performed. An order number will also be issued. If all criteria are not met or additional information or review is needed: The case is forwarded to a registered nurse (RN) reviewer. The RN reviewer uses additional clinical experience and knowledge to evaluate the request against clinical guidelines. The RN reviewer has the authority to issue order numbers in the event that he or she determines that the request is consistent with AIM s clinical criteria and HealthKeepers, Inc. medical policy. If an order number still cannot be issued, the RN reviewer will contact the ordering provider to schedule a peer-to-peer discussion with an AIM physician (MD) reviewer. The physician reviewer can approve the case based on a review of information collected or through their discussion with the ordering provider. The AIM physician reviewer will refer the case back to HealthKeepers, Inc. when one or more of the following occurs: The AIM physician reviewer cannot approve the case based on the information previously collected. The AIM physician reviewer is unable to reach the ordering provider to discuss the case. The AIM physician reviewer is unable to approve the case based on the information supplied by the ordering provider during the peer-to-peer discussion. 6. What does the AIM order number look like? AIM s order numbers are eight digits in length. 7. How long is an order number valid? An order number issued by AIM is valid for 30 days. 8. Can AIM handle multiple requests per call? Yes, imaging requests for multiple members can be made on the same call. 9. Does AIM need to know when the procedure is scheduled? No, although the order number should be issued prior to scheduling the study. ProviderPortal prevents a retrospective case from being created. 10. Can members contact AIM? Members should contact HealthKeepers, Inc. directly if they have any questions.
3 Anthem HealthKeepers MMP Page 3 of What information will AIM require in order to evaluate an imaging request? Please refer to the checklist below to ensure you have all the necessary information available prior to submitting a request to AIM: Member s name, date of birth and HealthKeepers, Inc. health plan ID number Ordering provider information Imaging provider information Imaging exam(s) being requested (body part, right, left or bilateral) Patient diagnosis (suspected or confirmed) Clinical symptoms/indications (intensity/duration) For most situations, the above will suffice. For complex cases, more information may be necessary, including the results of past treatment history (previous tests, duration of previous therapy, relevant clinical medical history). 12. How can I determine whether an order number has been obtained for a member? To determine whether an order number has been obtained for a member enrolled in HealthKeepers, Inc, call AIM at Or go to the AIM website. Providers will need to log in as a registered user or register to access the portal. 13. What happens if a member is approved for a specific procedure (e.g., a CT scan of the abdomen) and during the course of this procedure, the radiologist or rendering provider feels that an additional procedure (e.g., a CT scan of the pelvis) is required that also requires precertification? The radiologist or rendering provider should proceed with the additional procedure. If this occurs, he or she should inform the member s ordering provider that an additional test was performed on the same day. AIM must be contacted for an order number for the additional procedure no later than two business days after the service was rendered. The pertinent clinical information supporting the additional procedure must be available at the time AIM is contacted. 14. If a service is already authorized by AIM and needs to be rescheduled beyond the original 30-day authorization period, do I need a new order number? If the date of the service is extended beyond the original 30-day authorization period, a new authorization must be requested through AIM. 15. If the authorization is done via the telephone or via the ProviderPortal, is a letter sent to the provider regarding approval or denial of the authorization? Yes, approval or denial letters will be sent to ordering providers who request precertification of high-tech radiology imaging services. A case received on Monday must be closed by 5 p.m. Eastern time on Wednesday For standard authorizations, AIM must issue a decision within two business days of obtaining all necessary information; however, they have up to 14 calendar days to make the decision if they have not received all necessary information. For expedited authorizations, AIM must issue a decision within three business days of obtaining all
4 Anthem HealthKeepers MMP Page 4 of 6 necessary information; however, AIM also has up to three working days to issue a decision if they do not receive all the necessary information. 16. What Pre-Exam Questions (PEQs) will be asked? HealthKeepers, Inc. requests that the ordering provider complete a set of voluntary PEQs for cardiac exams, including Cardiac CT/CTA and Cardiac PET. For example, the following questions/requests for information will be asked for Myocardial Perfusion Imaging (MPI) and Spine Echo (SE): Differential diagnosis Does the patient have established coronary artery disease (CAD)? If yes, please indicate which exams were performed and when. o Myocardial infarction o Angioplasty, stenting or bypass o Catheterization showing > 70% stenosis Does the patient have chest pain? If yes, please provide additional information (nature/description/location). Does the patient have any additional symptoms? If yes, please describe the additional symptoms. Patient Risk Assessment: o Current weight o Current blood pressure o Current smoker o Current total cholesterol o Coexisting conditions (diabetes, abdominal aortic aneurysm, symptomatic peripheral vascular disease, history of CVA/TIA/CEA, renal insufficiency/failure) o Family History of CAD (Father/Brother/Son < 50 years old, mother/sister/daughter < 60 years old) When did the patient last receive an EKG? Please provide the results of the most recent EKG test. Is the patient able to walk on a treadmill? Has the patient received any cardiac exam/test in the last two years? If yes, please provide the date and results for the exam(s). o Exercise stress test o Coronary CT angiography o Cardiac catheterization Preoperative evaluation (if performing surgery, please indicate type and date) Does the patient have a history of heart transplant?
5 17. Why is HealthKeepers, Inc. requesting PEQs? Anthem HealthKeepers MMP Page 5 of 6 PEQs are included in the review process for cardiac imaging exams to risk-stratify patients by identifying the common risk factors for cardiac disease. The PEQs address blood pressure, lipid status, tobacco use and diabetes. 18. If I do not complete the PEQs, will there be an impact on my cardiac imaging services order request results? While the completion of the PEQs for Cardiac CT/CTA, Cardiac PET, MPI and SE is currently voluntary, it is important to note that, because these exams are used to assess the risk of CAD, they facilitate the order review process. Completing the PEQs for these exams will reduce the time it takes for you to receive an order number. Because there is no correlation between CAD and all other cardiac exams (TTE, TEE, Blood Pool Imaging/MUGA and Cardiac MRI), PEQs for adult patients are not included. In addition, because the PEQs do not currently take age into consideration, they will not be requested for pediatric patients (under the age of 19). 19. How do I complete the PEQs? Complete PEQs when submitting your request via the web or by phone for an order number for cardiac imaging services. 20. Who develops the clinical criteria for the program? Clinical appropriateness guidelines developed by AIM are updated at least once a year and are reviewed by: An independent physician review board, including cardiologists, orthopedic surgeons, radiologists, neurologists and neurosurgeons Client medical directors Local imaging advisory council (representing local physician communities) Physician review panels In addition, AIM s guidelines are submitted as part of AIM s accreditation process to the National Committee for Quality Assurance (NCQA) and the American Accreditation HealthCare Commission (URAC). 21. What methods and resources are used to develop the guidelines? Development of AIM s clinical appropriateness guidelines involves integration of medical information from multiple sources to support the reproducible use of high quality and state-of-the-art diagnostic imaging services. The process for criteria development is based on technology assessment, peer-reviewed medical literature, including clinical outcomes research, and consensus opinion in medical practice. The primary resources used for AIM s diagnostic imaging clinical appropriateness guidelines development include: American College of Radiology Appropriateness Criteria American College of Cardiology Appropriateness Criteria American Heart Association
6 Anthem HealthKeepers MMP Page 6 of 6 American Institute of Ultrasound in Medicine American Cancer Society American Academy of Neurology American Academy of Pediatrics Society of Interventional Radiology Society of Nuclear Medicine Agency for Healthcare Research and Quality Centers for Medicare and Medicaid Services National Guideline Clearinghouse
Diagnostic Imaging Management
Diagnostic Imaging Management Frequently Asked Questions (FAQ) from Providers Updated August 1, 2013 Program Overview Q1. What is AIM Specialty Health SM (AIM)? A1. AIM Specialty Health SM (AIM) is a leading
More informationRadiology Quality Initiative (RQI) Program Answers to Frequently Asked Questions
Radiology Quality Initiative (RQI) Program Answers to Frequently Asked Questions Program Overview... 2 Program Requirements... 4 Claims... 7 Online Tools... 7 Standards for Imaging Guidelines... 8 Page
More informationRadiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan
Radiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan 1. What is the UnitedHealthcare Radiology Prior Authorization Program? Acting on behalf of our Medicaid
More informationRadiology Prior Authorization Program Frequently Asked Questions (FAQ) For AmeriChoice by UnitedHealthcare, Tennessee
Radiology Prior Authorization Program Frequently Asked Questions (FAQ) For AmeriChoice by UnitedHealthcare, Tennessee 1. What is the AmeriChoice Radiology Prior Authorization Program? Acting on behalf
More informationWorking with Anthem Subject Specific Webinar Series
Working with Anthem Subject Specific Webinar Series E-Tools for Providers Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone This presentation
More informationRadiology Management Program
Highmark Blue Shield Radiology Management Program Prior Authorization Reference Guide* Effective with service dates of April 1, 2006, and beyond *Originally published December 2005; revised January 2007
More informationEVIDENCE-BASED HEALTHCARE SOLUTIONS. CareCore National. Prepared for. Prepared for. October 23, 2009
EVIDENCE-BASED HEALTHCARE SOLUTIONS CareCore National Radiology CARECORE Program NATIONAL RADIOLOGY Frequently BENEFIT Asked MANAGEMENT Questions PROPOSAL Prepared for Prepared for October 23, 2009 March
More informationCARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION
CLINICAL POLICY CARDIOLOGY PROCEDURES REQUIRING PRECERTIFICATION Policy Number: CARDIOLOGY 026.6 T2 Effective Date: May 1, 2015 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE... BENEFIT
More informationDiagnostic Imaging Prior Review Code List 3 rd Quarter 2016
Computerized Tomography (CT) Abdomen 6 Abdomen/Pelvis Combination 101 Service 74150 CT abdomen; w/o 74160 CT abdomen; with 74170 CT abdomen; w/o followed by 74176 Computed tomography, abdomen and pelvis;
More informationCARDIAC CARE. Giving you every advantage
CARDIAC CARE Giving you every advantage Getting to the heart of the matter The Cardiovascular Program at Northwest Hospital & Medical Center is dedicated to the management of cardiovascular disease. The
More informationLEADING-EDGE Cardiovascular Care
LEADING-Edge Cardiovascular Care Coral Gables Hospital North Shore Medical Center Hialeah Hospital Delray Medical Center Good Samaritan Medical Center Palm Beach Gardens Medical Center St. Mary s Medical
More informationAI CPT Codes. x x. 70336 MRI Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)
Code Category Description Auth Required Medicaid Medicare 0126T IMT Testing Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor
More informationCPT * Codes Included in AIM Preauthorization Program for 2013 With Grouper Numbers
CPT * Codes Included in AIM Preauthorization Program for 2013 With Grouper Numbers Computerized Tomography (CT) CPT Description Abdomen 74150 CT abdomen; w/o contrast 6 74160 CT abdomen; with contrast
More informationSpecific Basic Standards for Osteopathic Fellowship Training in Cardiology
Specific Basic Standards for Osteopathic Fellowship Training in Cardiology American Osteopathic Association and American College of Osteopathic Internists BOT 07/2006 Rev. BOT 03/2009 Rev. BOT 07/2011
More informationHUSKY Health Program and Charter Oak Health Plan Radiology Benefits Management Program
HUSKY Health Program and Charter Oak Health Plan Radiology Benefits Management Program Training Agenda Presentation Overview Introduction of Presenters Radiology Benefits Management Program Overview Prior
More informationHEART CENTER. Touching Lives
HEART CENTER Touching Lives with INNOVATIVE TOOLS and an EXPERIENCED TEAM THE HEART MATTERS If you or someone you love is faced with a heart problem, you want to put your trust in experienced professionals
More informationUW MEDICINE PATIENT EDUCATION. Aortic Stenosis. What is heart valve disease? What is aortic stenosis?
UW MEDICINE PATIENT EDUCATION Aortic Stenosis Causes, symptoms, diagnosis, and treatment This handout describes aortic stenosis, a narrowing of the aortic valve in your heart. It also explains how this
More informationRADIOLOGY HOUSE STAFF MANUAL
RADIOLOGY HOUSE STAFF MANUAL The Department of Radiology offers a wide range of services/procedures and operates 12 divisions/sections, which are listed separately below. The procedures offered are listed
More informationComputed Tomography, Head Or Brain; Without Contrast Material, Followed By Contrast Material(S) And Further Sections
1199SEIU BENEFIT AND PENSION FUNDS High Tech Diagnostic Radiology and s # 1 70336 Magnetic Resonance (Eg, Proton) Imaging, Temporomandibular Joint(S) 2 70450 Computed Tomography, Head Or Brain; Without
More informationListen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
More informationPREVENTIVE CARE See the REHP Benefits Handbook for a list of preventive benefits* MATERNITY SERVICES Office visits Covered in full including first
Network Providers Non Network Providers** DEDUCTIBLE (Per Calendar Year) None $250 per person $500 per family OUT-OF-POCKET MAXIMUM (When the out-of-pocket maximum is reached, benefits are paid at 100%
More informationCPT Radiology Codes Requiring Review by AIM Effective 01/01/2016
CPT Radiology Codes Requiring Review by AIM Effective 01/01/2016 When a service is authorized only one test per group is payable. *Secondary codes or add-on codes do not require preauthorization or separate
More informationHeart Center Packages
Heart Center Packages For more information and appointments, Please contact The Heart Center of Excellence at the American Hospital Dubai Tel: +971-4-377-6571 Email: heartcenter@ahdubai.com www.ahdubai.com
More informationHealthCare. HealthCare. HealthCare News. Title font is: Wiesbaden Swing LT Std. Table of Contents. Coding and Billing
#352 March 2013 THORConnect.org Table of Contents Coding and Billing Psychiatric and Substance Abuse Services Institutional... 1 Psychiatric Services... 1 Inpatient... 2 Residential Treatment Centers (RTC)...
More informationBayfront. Heart Center. www.bayfrontheart.org
Bayfront Heart Center www.bayfrontheart.org THE HEART OF THE MATTER At the Bayfront Heart Center, the leading cardiac facility in the area, we are fully equipped to treat all aspects of cardiovascular
More informationMARKET CONDUCT EXAMINATION REPORT. AETNA HEALTH INC. (a Delaware corporation) NAIC#95245
MARKET CONDUCT EXAMINATION REPORT ON AETNA HEALTH INC. (a Delaware corporation) NAIC#95245 980 Jolly Road Blue Bell, PA 19422 As of April 6, 2010 Table of Contents EXECUTIVE SUMMARY... 2 INTRODUCTION...
More informationControlling Advanced Diagnostic Imaging With Specialty Benefits Management: Two Case Studies. Mark D. Hiatt, MD, MBA, MS & Timothy R.
Controlling Advanced Diagnostic Imaging With Specialty Benefits Management: Two Case Studies Mark D. Hiatt, MD, MBA, MS & Timothy R. Johnstad, MBA 1 Agenda Introduction to Speaker & HealthHelp Objectives
More informationU.S. Bureau of Labor Statistics. Radiology Tech
From the: U.S. Bureau of Labor Statistics Radiology Tech What They Do Radiologic technologists (RTs) perform diagnostic imaging examinations, such as x rays, on patients. Duties RTs typically do the following:
More informationCPT CODE PROCEDURE DESCRIPTION. CT Scans 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST
CPT CODE PROCEDURE DESCRIPTION CT Scans 70450 CT HEAD/BRAIN W/O CONTRAST 70460 CT HEAD/BRAIN W/ CONTRAST 70470 CT HEAD/BRAIN W/O & W/ CONTRAST 70480 CT ORBIT W/O CONTRAST 70481 CT ORBIT W/ CONTRAST 70482
More informationMANCHESTER Lung Cancer Screening Program Dartmouth-Hitchcock Manchester 100 Hitchcock Way Manchester, NH 03104 (603) 695-2850
LEBANON Lung Cancer Screening Program One Medical Center Drive Lebanon, NH 03756 (603) 650-4400 (866) 966-1601 Toll-free cancer.dartmouth.edu/lungscreening MANCHESTER Lung Cancer Screening Program Dartmouth-Hitchcock
More informationGroup Critical Illness Insurance Provides lump-sum cash benefits that can help with daily expenses
What can living with a critical illness mean to you? Daily out-of-pocket expenses for fighting the disease while still paying your bills! GROCERIES CAR HOME PRESCRIPTIONS Benefit coverage for A Plus Benefits
More informationMichigan Heart & Vascular Institute ON THE ST. JOSEPH MERCY HOSPITAL CAMPUS, ANN ARBOR, MICHIGAN
ON THE ST. JOSEPH MERCY HOSPITAL CAMPUS, ANN ARBOR, MICHIGAN Dear Colleague: Cardiovascular medicine has marked an important milestone in the battle against heart disease. The latest available data indicates
More informationCHAPTER 7: UTILIZATION MANAGEMENT
OVERVIEW The Plan s Utilization Management (UM) program is collaboration with providers to promote and document the appropriate use of health care resources. The program reflects the most current utilization
More informationAnthem Blue Cross and Blue Shield in New Hampshire Precertification Guidelines
Anthem Blue Cross and Blue Shield in New Hampshire Precertification Guidelines The following guidelines apply to Anthem Blue Cross and Blue Shield ( Anthem ) products issued and delivered by Anthem in
More informationEVALUATION OF MEDICAL RECORDS COMPLETENESS IN THE ADULT CARDIOLOGY CLINIC AT NORK MARASH MEDICAL CENTER
American University of Armenia Center for Health Services Research and Development Nork Marash Medical Center EVALUATION OF MEDICAL RECORDS COMPLETENESS IN THE ADULT CARDIOLOGY CLINIC AT NORK MARASH MEDICAL
More informationAnthem Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield 2008 Quality Incentive Program for Cardiology and Obstetrics/Gynecology Part of the Anthem Quality Insights suite of innovative, quality recognition and health improvement
More informationDIAGNOSTIC IMAGING SERVICES
DIAGNOSTIC IMAGING SERVICES Policy NHP reimburses contracted providers for medically necessary diagnostic imaging services delivered in non-institutional settings such as an office or free-standing facility,
More informationMore local. More locations.
Updated April 2015 Service Sites Directory More local. More locations. Service Area and Locations RHODE ISLAND Pawtucket Providence Warwick Cardiac Testing Center Middletown Swansea (Cardiopulmonary) Portsmouth
More informationWellPoint Cancer Care Quality Program Provider FAQs
WellPoint Cancer Care Quality Program Provider FAQs WellPoint Cancer Care Quality Program What is the WellPoint Cancer Care Quality Program? Anthem Blue Cross and Blue Shield (Anthem) is pleased to bring
More informationPurpose Members of the Department of Cardiology will provide cardiology services to patients of McLaren Greater Lansing.
Purpose Members of the Department of Cardiology will provide cardiology services to patients of McLaren Greater Lansing. Qualifications To be eligible for core privileges in the Department of Cardiology,
More informationCOMPREHENSIVE PRIOR AUTHORIZATION LISTS NJ FAMILYCARE/MEDICAID & DUAL COMPLETE HMO SNP PRODUCTS EFFECTIVE 7/1/13
TO ALL HEALTHCARE PROFESSIONALS: COMPREHENSIVE PRIOR AUTHORIZATION LISTS NJ FAMILYCARE/MEDICAID & DUAL COMPLETE HMO SNP PRODUCTS EFFECTIVE 7/1/13 BEFORE SEEKING PRIOR AUTHORIZATION, PLEASE VERIFY MEMBER
More informationHEART & VASCULAR SERVICES. Heart & Vascular Services www.mhsystem.org
HEART & VASCULAR SERVICES Heart & Vascular Services www.mhsystem.org Heart Services Testing Before Your Procedure If you are scheduled for a procedure in the catheterization lab, there will be blood work
More informationI. Current Cardiac Rehabilitation Requirements
CLIENT ADVISORY July 24, 2009 CMS Proposes Changes to Cardiac Rehabilitation Program Design and Physician Supervision Requirements The Centers for Medicare and Medicaid Services (CMS) recently published
More informationCARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN
HOSPITALIZATION CASE #: 2 8 8 0 H FY288BH4CN Has the participant indicated any of the following reasons for being admitted overnight for this case? 1. Suspected or confirmed problems with the heart, circulation,
More informationHealth Care Careers in the Field of Imaging. Shari Workman, MSM,PHR,CIR MultiCare Health System Senior Recruiter/Employment Specialist
Health Care Careers in the Field of Imaging Shari Workman, MSM,PHR,CIR MultiCare Health System Senior Recruiter/Employment Specialist What is Health Care Imaging? Technologists working with patients, using
More informationAnthem Blue Cross and Blue Shield in Connecticut Precertification Guidelines
Anthem Blue Cross and Blue Shield in Connecticut Precertification Guidelines The following guidelines apply to Anthem Blue Cross and Blue Shield ( Anthem ) products issued and delivered by Anthem in Connecticut.
More informationCh. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES GENERAL PROVISIONS
Ch. 138 CARDIAC CATHETERIZATION SERVICES 28 138.1 CHAPTER 138. CARDIAC CATHETERIZATION SERVICES Sec. 138.1 Principle. 138.2. Definitions. GENERAL PROVISIONS PROGRAM, SERVICE, PERSONNEL AND AGREEMENT REQUIREMENTS
More informationGroup Critical Illness Insurance Provides lump-sum cash benefits that can help with daily expenses
What can living with a critical illness mean to you? Daily out-of-pocket expenses for fighting the disease while still paying your bills! GROCERIES CAR HOME PRESCRIPTIONS Benefit coverage for Catholic
More informationEducational Goals & Objectives
Educational Goals & Objectives The Cardiology rotation will provide the resident with an understanding of cardiovascular physiology and its broad systemic manifestations. The resident will have the opportunity
More informationAccreditations and Certifications. American College of Surgeons (ACS) & State of CO Level II Trauma Center
Accreditations and Certifications The Medical Center of Aurora American College of Surgeons (ACS) & State of CO Level II Trauma Center Accredited by The Joint Commission (TJC) Primary Stroke Center Certification
More informationWhat Does it Mean When Patients Choose Wisely? David Ansley Senior Analyst, Health Product Development Consumer Reports
What Does it Mean When Patients Choose Wisely? David Ansley Senior Analyst, Health Product Development Consumer Reports People are realizing that more medicine is not necessarily better. And that we re
More informationAnthem Blue Cross and Blue Shield 2014 Quality-In-Sights Cardiology and Obstetrics/Gynecology Quality Incentive Program
Anthem Blue Cross and Blue Shield 2014 Quality-In-Sights Cardiology and Obstetrics/Gynecology Quality Incentive Program Part of the Anthem Quality-In-Sights suite of innovative, quality recognition and
More informationBASIC STANDARDS FOR RESIDENCY TRAINING IN CARDIOLOGY
BASIC STANDARDS FOR RESIDENCY TRAINING IN CARDIOLOGY American Osteopathic Association and the American College of Osteopathic Internists Specific Requirements For Osteopathic Subspecialty Training In Cardiology
More information12.4 million people alive today have a history of heart attack, angina pectoris (chest pains) or both. 1. solutions. Benefit coverage for
PROTECTION solutions Benefit coverage for HSP2 12.4 million people alive today have a history of heart attack, angina pectoris (chest pains) or both. 1 1 2009 Heart and Stroke Statistical Update, American
More informationCY2015 MA HSD Provider and Facility Specialties and Network Adequacy Criteria Guidance Table of Contents
CY2015 MA HSD Provider and Facility Specialties and Network Adequacy Criteria Guidance Table of Contents Summary of Significant Changes to the CY2015 MA Provider and MA Facility Criteria... 1 HSD Provider
More informationWhat are some common uses of the procedure?
Scan for mobile link. Cardiac Nuclear Medicine Cardiac nuclear medicine imaging evaluates the heart for coronary artery disease and cardiomyopathy. It also may be used to help determine whether the heart
More informationThe Lewin Group undertook the following steps to identify the guidelines relevant to the 11 targeted procedures:
Guidelines The following is a list of proposed medical specialty guidelines that have been found for the 11 targeted procedures to be included in the Medicare Imaging Demonstration. The list includes only
More informationACUTE STROKE PATHWAY
ACUTE STROKE PATHWAY THERE IS A NEED FOR STATEWIDE STROKE SYSTEM OF CARE ALL MISSISSIPPIANS SHOULD BE ABLE TO ACCESS NEW PROTOCOLS FOR STROKE TREATMENT JOINT EFFORT WITH EMS, PHYSICIANS, HOSPITALS AND
More informationTest Request Tip Sheet
With/Without Contrast CT, MRI Studies should NOT be ordered simultaneously as dual studies (i.e., with and without contrast). Radiation exposure is doubled and both views are rarely necessary. The study
More informationFirst floor, Main Hospital North Services provided 24/7 365 days per year
First floor, Main Hospital North Services provided 24/7 365 days per year General Radiology (X-ray) Fluoroscopy Ultrasound (Sonography) Nuclear Medicine P.E.T. imaging Computed Tomography (CT scan) Magnetic
More informationCRITICAL ILLNESS CLAIM FORM
Send all claims to: Continental American Insurance Company Critical Illness Claims Processing Unit Post Office Box 427 Columbia, South Carolina 29202 Phone: (800)-433-3036 Fax: (866)-849-2970 CRITICAL
More informationBOARD MEETING: March 27-28, 2007. Silver Cross Hospital and Medical Center, Joliet STATE AGENCY REPORT
DOCKET ITEM NUMBER: NA BUSINESS ITEM: REQUESTING ENTITY and LOCATION: BOARD MEETING: March 27-28, 27 Declaratory Ruling Request Silver Cross Hospital and Medical Center, Joliet PROJECT NUMBER: NA I. Request
More informationII.D. HOSPITALS AND CLINICS
II.D. HOSPITALS AND CLINICS A.G. HOLLEY STATE HOSPITAL COMPLEX 1199 West Lantana Road Lantana, FL 33462 Phone: (561) 582-5666 (800) 482-4636 (Tuberculosis Hotline) Hours: 24 hour facility Fees: Contact
More informationCARDIOLOGY Delineation of Privileges
CARDIOLOGY Delineation of Privileges APPLICANT: INITIAL APPOINTMENT REQUIREMENTS: BASIC EDUCATION: M.D. or D.O. from an accredited school of medicine or osteopathy. Successful completion of an ACGME or
More informationHEALTH CARE DESIGNED AROUND You.
HEALTH CARE DESIGNED AROUND You. Health care designed around you means... Access to the best care {where you live and work. What does health care designed around you really mean? In a time when health
More informationCritical Illness Insurance
Critical Illness Insurance from Allstate Benefits Benefits are paid for you and covered family members Protection for out-of-pocket expenses upon a positive diagnosis CHOOSE You choose the benefits to
More informationOFFICE OF GROUP BENEFITS 2014 OFFICE OF GROUP BENEFITS CDHP PLAN FOR STATE OF LOUISIANA EMPLOYEES AND RETIREES PLAN AMENDMENT
OFFICE OF GROUP BENEFITS 2014 OFFICE OF GROUP BENEFITS CDHP PLAN FOR STATE OF LOUISIANA EMPLOYEES AND RETIREES PLAN AMENDMENT This Amendment is issued by the Plan Administrator for the Plan documents listed
More informationTable of Contents Billing & Reimbursement for Hospital Services
Table of Contents Billing & Reimbursement for Hospital Services Overview...8.1 Inpatient Services...8.1 Maternity Admissions... 8.1 Outpatient Services...8.1 Cardiology... 8.3 Diabetic education... 8.3
More informationOregon CPT Preapproval Grid
* The following grid only identifies items that require preapproval from. Breast Pumps Notes: No preapproval required for 1st month rental; beyond one month rental requires preapproval Genetic Testing
More informationHighResolution Consistent and Reliable Results from Baylor Diagnostic Imaging Centers
HighResolution Consistent and Reliable Results from Baylor Diagnostic Imaging Centers Interventional Radiology Often Proves Effective Alternative to Surgery Baylor University Medical Center at Dallas offers
More informationCardiac Rehabilitation and Intensive Cardiac Rehabilitation JA6850
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation JA6850 Related CR Release Date: March 21, 2010 Revised Date Job Aid Revised: November 17, 2010 Effective Date: January 1, 2010 Implementation
More informationGroup Critical Illness Insurance Provides lump-sum cash benefits that can help with daily expenses
What can living with a critical illness mean to you? Daily out-of-pocket expenses for fighting the disease while still paying your bills! GROCERIES CAR HOME PRESCRIPTIONS Group Critical Illness Insurance
More information2015 Medicare Advantage Summary of Benefits
2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015
More informationSecure Plan (HMO) January 1, 2015 December 31, 2015 SECTION I INTRODUCTION. You have choices about how to get your Medicare benefits
Secure Plan (HMO) January 1, 2015 December 31, 2015 SECTION I INTRODUCTION This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list every
More information2011 Revisions to the MIS Standards
March 17, 2011 2011 Revisions to the MIS Standards The following list highlights the major revisions made to the MIS Standards for implementation April 1, 2011. A more detailed summary of these revisions
More informationDiagnostic and Therapeutic Procedures
Diagnostic and Therapeutic Procedures Diagnostic and therapeutic cardiovascular s are central to the evaluation and management of patients with cardiovascular disease. Consistent with the other sections,
More informationWhat can living with a critical illness mean to you?
What can living with a critical illness mean to you? Daily out-of-pocket expenses for fighting the disease while still paying your bills! GROCERIES CAR HOME PRESCRIPTIONS Benefit coverage for Broward County
More informationMeaningful Use: Registration, Attestation, Workflow Tips and Tricks
Meaningful Use: Registration, Attestation, Workflow Tips and Tricks Allison L. Weathers, MD Medical Director, Information Services Rush University Medical Center Gregory J. Esper, MD, MBA Vice Chair, Neurology
More informationUnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Plan 7EG of Educators Benefit Services, Inc. Enrolling Group Number: 717578 Effective Date: January 1, 2012
More informationPatient Information & Medical Screening Form
Patient Information & Medical Screening Form Name: Date of Birth: Social Security Number: Status: Single Married Divorced Widowed Other Ethnicity: Caucasian African American Hispanic Asian American Indian
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationSteps to getting a diagnosis: Finding out if it s Alzheimer s Disease.
Steps to getting a diagnosis: Finding out if it s Alzheimer s Disease. Memory loss and changes in mood and behavior are some signs that you or a family member may have Alzheimer s disease. If you have
More informationUnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage
UnitedHealthcare Choice Plus UnitedHealthcare Insurance Company Certificate of Coverage For the Health Savings Account (HSA) Plan 7PD of Educators Benefit Services, Inc. Enrolling Group Number: 717578
More informationHealth Plan of Nevada, Inc. ( HPN ) Small Business Point-Of-Service ( POS ) Rider to the Small Business Evidence of Coverage ( EOC )
Health Plan of Nevada, Inc. ( HPN ) Small Business Point-Of-Service ( POS ) Rider to the Small Business Evidence of Coverage ( EOC ) This Rider is a supplement to your EOC issued by HPN. Subject to the
More informationA Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair
A Patient s Guide to Minimally Invasive Abdominal Aortic Aneurysm Repair Table of Contents The AFX Endovascular AAA System............................................ 1 What is an Abdominal Aortic Aneurysm
More informationSHADY GROVE ADVENTIST HOSPITAL DEPARTMENT OF MEDICINE CARDIOLOGY SECTION RULES AND REGULATIONS
DEPARTMENT OF MEDICINE I. Purpose A Cardiology Section, within the Department of Medicine will be established pursuant to Article X, Section 7 of the Bylaws of the Medical Staff. This action is taken primarily
More informationAugust 13, 2014. Dear Administrator Tavenner:
Marilyn B. Tavenner Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445 G 200 Independence Avenue, SW Washington, DC
More information2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
More informationGroup Critical Illness Insurance Provides lump-sum cash benefits that can help with daily expenses
What can living with a critical illness mean to you? Daily out-of-pocket expenses for fighting the disease while still paying your bills! GROCERIES CAR HOME PRESCRIPTIONS Group Critical Illness Insurance
More informationChristopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona
Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona Areas to be covered Historical, current, and future treatments for various cardiovascular disease: Atherosclerosis (Coronary
More informationRADIOLOGY SERVICES. By Dr Lim Eng Kok 1
INTRODUCTION RADIOLOGY SERVICES By Dr Lim Eng Kok 1 Radiology is the branch of medicine that deals with the use of ionising (e.g. x- rays and radio-isotopes) and non-ionising radiation (e.g. ultrasound
More informationPPO product with drug plan being offered for January 1, 2013
PPO product with drug plan being offered for January 1, 2013 Austin area: 8 counties Dallas/Fort Worth area: 4 counties Houston area: 3 counties Austin Area Counties (8) Bastrop Burnet Caldwell Fayette
More informationMeasure #236 (NQF 0018): Controlling High Blood Pressure National Quality Strategy Domain: Effective Clinical Care
Measure #236 (NQF 0018): Controlling High Blood Pressure National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS F INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage of patients
More informationGroup Critical Illness Insurance Provides lump-sum cash benefits that can help with daily expenses
What can living with a critical illness mean to you? Daily out-of-pocket expenses for fighting the disease while still paying your bills! GROCERIES CAR HOME PRESCRIPTIONS Benefit coverage for Cobb County
More informationTHE CLEVELAND CLINIC. personal. Health. Management. Program
THE CLEVELAND CLINIC personal Health Management Program Our Personal Health Management Program offers a comprehensive examination in a package tailored to meet your unique medical needs. Expert Care The
More informationPerioperative Cardiac Evaluation
Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project
More informationHealth Plans That Fit Your Life 2016
Health Plans That Fit Your Life 2016 Maine 121415-02-0004 Find the one that s right for you. Certified by the Health Insurance Marketplace My husband and I both work for ourselves so Health Options has
More informationYour Guide to Anthem HealthKeepers Plus Web Updates and Other Changes
Your Guide to Anthem HealthKeepers Plus Web Updates and Other Changes Effective November 1, 2013, we have made some great changes to our provider website and a few of our tools. Recently, we announced
More informationRenovascular Disease. Renal Artery and Arteriosclerosis
Other names: Renal Artery Stenosis (RAS) Renal Vascular Hypertension (RVH) Renal Artery Aneurysm (RAA) How does the normal kidney work? The blood passes through the kidneys to remove the body s waste.
More informationHNE Premier 1 (HMO) and HNE Premier 2 (HMO)
2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I
More information