Horizon BCBS NJ: Radiology/Imaging Program Update - PA/MND Review to be required for Out-of-Network Facilities/Sites
Horizon BCBSNJ collaborates with eviCore healthcare to manage prior authorization and medical necessity determination (PA/MND) review of advanced imaging services through our Radiology/Imaging Services program.
Effective April 1, 2021, eviCore will also perform PA/MND reviews for advanced imaging services to be performed at facilities/sites that DO NOT participate with Horizon BCBSNJ. This change will help ensure standards of safety and care are uniformly applied to Horizon BCBSNJ’s members regardless of where services are rendered. PA/MND review is required for members enrolled in insured Horizon HMO, Horizon POS, Horizon Direct Access, Horizon PPO, Horizon EPO, Horizon Medicare Advantage and NJ DIRECT plans. PA/MND reviews do not apply to radiology/imaging services rendered during ER visits or inpatient stays.