As of March 1, 2007, consultation is required for the following outpatient high-tech imaging studies:
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Positive emission tomography (PET)
Providers must contact HealthHelp, Medica's radiology management vendor, to initiate the consultation process. Consultation requests must be received prior to the imaging being performed. Consultation is not required for services performed in the following setting: inpatient, urgent care centers or emergency rooms.
How to Request a Consultation.
HealthHelp is a national radiology management vendor. Their RadConsult program is a notification and consultation program where recommendations are made in accordance with acceptable medical standards and appropriateness of care guidelines for high-tech imaging, such as those of the American College of Radiology. The goals of the program are to ensure the appropriate test for the diagnosis, eliminate inappropriate radiology procedures, track and trend physician ordering patterns and decision-making based on evidence-based medicine.
How to Contact HealthHelp.
Claims submitted by performing providers that have not had a consultation completed will be denied as performing provider liability; in this case, members can only be billed for applicable copayments, coinsurance and the member’s deductible amount.
How to Submit Claims.
Providers are able to obtain additonal information, including downloadable forms, under the High-Tech Imaging section of Claims Tools and Forms.