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Provider Manual

High End Imaging - Cardiac imaging and elective heart catheterization

Last Updated on July 23, 2019

High end imaging

Security Health Plan requires prior notification for outpatient high-end imaging tests for cardiac  imaging and elective heart catheterization. A complete list of CPT codes requiring notification can be found below.  Services performed without authorization may be denied for payment; and you may not seek reimbursement from members.

A prior notification is required for affiliated providers, facilities and ancillary providers for aforementioned high-end imaging procedures prior to performance, with administrative claim denial for non-compliance. The ordering provider maintains final decision authority of which high-end imaging test is performed. If an affiliated provider fails to prior notify, retro-notification will not be accepted.

The ordering provider or designee is responsible for obtaining a notification number prior to scheduling high-end outpatient imaging procedures. Prior notification can be completed on-line via Security Health Plan’s provider portal.

Authorization is required for:

  • Cardiac Advanced Imaging: CT, MR, PET
  • Nuclear Cardiology (includes nuclear stress testing)
  • Echo Stress Testing
  • Echocardiography
  • Diagnostic Heart Catheterization

Request Authorization

To request an authorization, submit your request online, by phone or fax:

Call eviCore at 1-888-693-3211 and choose option 4 for physicians. Here, providers may request or schedule a live peer-to-peer conversation. Please have the case or authorization number on the denial/fax letter ready.

Resources

View code list for high end imaging  prior authorizations for cardiac studies and elective heart catheterization
eviCore FAQs

eviCore healthcare’s Clinical Guidelines and request forms are available at:   www.evicore.com  or   click here    to access guidelines specific to Security Health Plan.    Please call the Client Provider Operations department at 1-800-646-0418, option 4, if you have any questions or need more information.