Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 5, 2024

Medicaid Site of Care Advanced Radiology Guideline Update

Effective September 1, 2024, Anthem will transition the site of care Clinical Criteria for advanced radiology to the following Carelon Medical Benefits Management, Inc. site of care guideline to perform medical necessity and clinical appropriateness.

For assistance with questions regarding the PA requirement change, please call Provider Services at one of the phone numbers listed below:

  • Hoosier Healthwise — 866-408-6132
  • Healthy Indiana Plan — 844-533-1995
  • Hoosier Care Connect — 844-284-1798
  • Indiana PathWays for Aging — 833-412-4405

Program

CUMG title

CPT® code

Site of Care for Advanced Imaging 2023-07-01 | Carelon Clinical Guidelines and Pathways (carelonmedicalbenefitsmanagement.com)

Advanced Imaging Appropriate Use Criteria: Site of Care

Radiology Code List

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-058058-24