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Managing the Risks of Radiation Exposure How to get the imaging tests you need, when you need them. Advanced imaging tools such as Computerized Axial Tomography (CAT scans) and Magnetic Resonance Imaging (MRI) can be the key to identifying underlying health conditions. But did you know that the American College of Radiology (ACR) estimates 20 percent to 30 percent of advanced imaging tests are not medically necessary?
Unnecessary advanced radiology procedures may contribute to increased radiation exposure; “false positives” leading either to more testing or unnecessary surgery; and exposure to higher radiation levels.* Anthem Blue Cross and Blue Shield’s radiation safety program is designed to improve the quality, safety, and appropriateness of advanced imaging services for members. Imaging Services Requiring Prior Authorization For some Anthem benefit plans, National Imaging Associates (NIA) must be contacted for a prior authorization before services are rendered in a nonemergency outpatient situation. The authorization will help ensure that the service being requested is the most appropriate approach to treatment. These services are:
However, when the pro-vider ordering or rendering these services is not a participating provider in the local network, or when a member is receiving these services out-of-state (even when the out-of-state provider participates with the local Blue Cross and Blue Shield plan), our health benefit plans require that members, not providers, obtain prior authorization for these services. Members with questions should contact the toll-free customer service number on the back of their member ID card. *European Commission, Radiation Protection Report 118, “Referral guidelines for imaging.” Directorate General for the Environment of the European Commission, 2000. McMurry, Inc. © 2009. All rights reserved. Click here for our disclaimer and more information about Healthy Solutions™.
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