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October 24, 2023

We’re committed to improving health outcomes and helping employers and members contain costs while ensuring providers follow the standard of care for medical procedures. To that end, we’re implementing an important enhancement to our Advanced Imaging Authorization program.

The Advanced Imaging Authorization program helps ensure members’ advanced diagnostic imaging services are based on widely accepted clinical judgment, so they receive the right care at the right time and in the right setting. Managing utilization of advanced imaging services through pre-authorization (PA) requirements helps ensure services are delivered only when medically necessary. This helps lower costs and improve treatment outcomes.

Effective Nov. 1, 2023, we’re adding nuclear medicine imaging to the Advanced Imaging Authorization program. Used primarily to evaluate organ function, nuclear medicine imaging produces images by detecting radiation from different parts of the body after a radioactive tracer is given to the patient. The images are digitally generated on a computer and transferred to a nuclear medicine physician, who interprets the images to make a diagnosis.

Adding PA requirements to nuclear medicine imaging and all advanced imaging services helps ensure providers follow the standard of care and avoid treatments that aren't medically necessary. The Advanced Imaging Authorization program is embedded in all plans for fully insured groups and available as a buy-up to ASO groups.

You can learn more about how the program supports high-quality care while reducing unnecessary expense this brochure.

Questions? Please contact your account representative.