Advanced Imaging and Cardiology Services Program

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Highmark has partnered with eviCore healthcare (eviCore) for the Advanced Imaging and Cardiology Services Program. This program incorporates a comprehensive, evidence-based clinical review including predictive intelligence, clinical decision support, and peer-to-peer discussions.

eviCore will manage the prior authorizations for advanced imaging and cardiology services for Highmark's fully insured Commercial, Children's Health Insurance Program (CHIP) of Pennsylvania, Medicare Advantage, and Affordable Care Act (ACA) members, plus members of select self-insured (Administrative Services Only) groups.

Effective Aug. 1, 2021, the program expanded to include out-of-area (OOA) and out-of-network (OON) cardiology and radiology services.

NOTE: The Federal Employee Program is excluded from this program.

Learn More About the Advanced Imaging and Cardiology Services Program

eviCore has a dedicated webpage for Highmark providers to conveniently access evidence-based clinical guidelines, the current CPT code list, important resources and recent announcements. We encourage you to visit their site to ensure that you have the most current information:

eviCore Webpage

Reference Materials

• Prior Authorization Quick Reference Guide
• In addition to this site and the eviCore webpage, you can also find any updates about the Advanced Imaging and Cardiology Services Program in the online provider portal and future issues of Provider News.

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Effective Jan. 1, 2024, Highmark began the utilization management of advanced imaging and cardiology services.

Prior authorization requirements for advanced imaging and cardiology services are applicable to all plans in Highmark's New York regions, including:

• Commercial
• Medicare Advantage (MA)
• Affordable Care Act (ACA)
• Federal Employee Program (FEP)
• Administrative Services Only (ASO)

These prior authorization requirements are subject to the member’s benefit plan.

Click below for medical policies that were established and became effective Jan. 1, 2024.

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October 2023 Medical Policy Update

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October 2023 Medical Policy Update

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eviCore healthcare is an independent company that does not provide Highmark products or services and is solely responsible for the products and services described here.