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ANTHEM
BLUE CROSS BLUE SHIELD (Indiana, Kentucky, Ohio)
ANTHEM HEALTH PLANS OF VIRGINIA, INC. d/b/a
Anthem Blue Cross and Blue Shield and its HMO Affiliates
(Virginia) [NEW - 4/2008]
BLUE CROSS BLUE SHIELD OF KANSAS CITY
(Kansas City service area)
CARE CORE NATIONAL
HIGHMARK BLUE CROSS BLUE SHIELD (Western
Pennsylvania)
OXFORD HEALTH PLANS
UNITED HEALTHCARE
[NEWLY UPDATED - 1/15/2008]
UNITED HEALTHCARE Wisconsin
ANTHEM
HEALTH PLANS OF VIRGINIA, INC. d/b/a
Anthem Blue Cross and Blue
Shield and its HMO Affiliates
(VIRGINIA)
April 2008 - Anthem Health Plans of Virginia, Inc. d/b/a Anthem
Blue Cross and Blue Shield and its HMO affiliates, released
the following announcement:
- Accreditation
requirements included to promote consistent, quality diagnostic
imaging services
- Standards
set by appropriate societal organizations have been adopted
and will be utilized to establish a certification process
for all imaging providers.
- Participating
provider currently performing or conducting any CT, CTA, MRI,
MRA, MRS, PET and/or Nuclear/Nuclear Cardiology studies shall
obtain accreditation from the American College of Radiology
(ACR) or Intersocietal Accreditation Commission (IAC) within
one year of the effective date of this Agreement. Accreditation
is required for each piece of equipment utilized in such studies
no later than April 1, 2009.
- Participating
provider not currently performing any CT, CTA, MRI, MRA, MRS,
PET and/or Nuclear/Nuclear Cardiology studies, but at any
point purchases or leases equipment and begins performing
such studies, participating provider shall obtain accreditation
from the American College of Radiology (ACR) or Intersocietal
Accreditation Commission (IAC) for each piece of equipment
utilized in such studies within one year of the date such
studies are first conducted.
- Additional
communication will follow on diagnostic imaging services,
equipment, licensure and/or accreditation.
DIAGNOSTIC
IMAGING SERVICES
Within
30 days of receipt of a written request, participating provider
shall provide to Health Plan such information as may be
requested concerning diagnostic imaging services, equipment,
licensure and/or accreditation.
Providers
that perform or conduct any CT, CTA, MRI, MRA, MRS, PET
and/or Nuclear/Nuclear Cardiology studies shall be accredited
by the American College of Radiology (ACR) or Intersocietal
Accreditation Commission (IAC) for each piece of equipment
utilized in such studies.
UNITED
HEALTHCARE
NEWLY UPDATED, 8/21/2008
- UnitedHealth Group (UnitedHealthcare) has released an announcement
requiring all freestanding imaging facilities and physician
offices performing nuclear medicine, nuclear cardiology and
PET procedures to apply for accreditation, and has
extended its original deadline (3/1/2008) for this requirement
until the fourth quarter of 2009. Please note:
UnitedHealthcare has stated that freestanding imaging sites
and/or provider clinics with imaging equipment who have not
received accreditation by the above deadline, but have submitted
their application to the ICANL, will be in a pending status
and will be considered in compliance with the accreditation
program.
Would
you like to know more about the UnitedHealthcare requirement?
For the details and official guidelines from UnitedHealthcare,
please visit their website section for Imaging
Accreditation. [Go to UnitedHealthcareOnline.com
> Clinician Resources > Radiology, and select
Imaging Accreditation from the vertical menu bar on the
left.] Get answers to common questions about the UnitedHealthcare
policy in Imaging
Accreditation: Frequently Asked Questions.>>
ANTHEM
BLUE CROSS BLUE SHIELD
(INDIANA, KENTUCKY, OHIO)
June 2006 - Community Insurance Company d/b/a Anthem Blue Cross
and Blue Shield in Ohio, Anthem Health Plans of Kentucky, Inc.
d/b/a Anthem Blue Cross and Blue Shield in Kentucky, and Anthem
Insurance Companies, Inc. d/b/a Anthem Blue Cross and Blue Shield
in Indiana now accepts Intersocietal Commission for the Accreditation
of Nuclear Medicine Laboratories (ICANL) from providers delivering
nuclear cardiology, nuclear medicine and PET imaging services.
In addition they accept Intersocietal Commission for the Accreditation
of Magnetic Resonance Laboratories (ICAMRL) from providers delivering
MRI services.
BLUE
CROSS BLUE SHIELD OF KANSAS CITY
(BCBSKC)
March 2006 - Blue Cross Blue Shield of Kansas City (BCBSKC)
has introduced a radiology privileging criteria program to practitioner
groups within its service area, stating that "criteria
implementation to all practitioner group sites will enhance
service quality and safety of the diagnostic imaging studies
delivered to our members and your patients." The objective
of BCBSKC's privileging program is to "facilitate and promote
an interrelated group of operational and professional criteria
to ensure that practitioner groups providing CT, MR, plain film
and PET services to membership are equipped and proficient to
extend quality-driven service, technologically sound delivery
and expertise within a safe and efficient environment."
Read
the official guidelines. >>
HIGHMARK
BLUE CROSS BLUE SHIELD
(PENNSYLVANIA)
In a July 13, 2004 letter to providers, Highmark Blue Cross
Blue Shield announced that, effective January 1, 2005, all providers
of diagnostic imaging services performed outside of a hospital
setting will be required to adhere to new privileging guidelines.
As detailed below, guidelines now exist related to each of the
accrediting bodies within the Intersocietal Accreditation Commission:
the ICANL, the ICAEL and the ICAVL.
According
to Augusta L. Kairys, Vice President of Provider Relations for
Highmark Blue Cross Blue Shield, "These guidelines have
been developed to promote reasonable and consistent quality
and safety standards for the provision of imaging services."
The new privileging guidelines apply to most Highmark health
plans in Western Pennsylvania (29 counties). Highmark plans
to implement the program in Central Pennsylvania (21 counties)
at a later date. Highmark has signed an agreement with National
Imaging Associates, Inc., a national radiology management company,
to help implement the program.
View
the new Highmark Privileging Guidelines. >>
Read
the Highmark Blue Cross Blue Shield press release. >>
CARE
CORE NATIONAL
Outpatient diagnostic imaging utilization management company
for HIP, Aetna and GHI requires all Nuclear Cardiology laboratories
to be accredited effective February 2, 2004. For more information,
visit the Care
Core National website.
UNITED
HEALTHCARE
(WISCONSIN)
Effective July 1, 2003, Wisconsin is the first state to link
reimbursement to accreditation, according to a policy by United
Healthcare of Wisconsin. The full story appears in the ICANL
Newsletter article, Wisconsin
To Require ICANL Nuclear Cardiology Accreditation, Fall
2000.
OXFORD
HEALTH PLANS
It is important to note that Oxford Health Plans requires its
nuclear cardiology laboratories to be accredited by either the
ICANL or the ACR to receive reimbursement for nuclear cardiology
claims. Oxford Health Plans announced that all physicians must
meet one of the following standards effective February 2, 2004
in order to be reimbursed for nuclear cardiology procedures:
1.
Certified by the Certification Board for Nuclear Cardiology
(CBNC)
2.
Board certified in Nuclear Medicine by the American Board
of Nuclear Medicine (ABNM)
3.
Board certified in Radiology by the American Board of Radiology
(ABR)
Get
more information by visiting the Oxford
Health Plans website, or from the ICANL Newsletter article,
Oxford
Health Plans Links Reimbursement To ICANL Accreditation,
Summer 2002.
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