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Provider Manual

High End Imaging - Cardiac imaging and elective heart catheterization

Last Updated on August 04, 2020

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.

  • Log into   https://www.evicore.com/
  • Phone at 1-888-444-6185
  • Fax a eviCore request form (available online) to 1-885-511-0403

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.