![]() There may be circumstances in which a patient’s clinical situation requires that he or she receive an MRI or CT scan in a hospital facility. Imaging Clinical Site of Care is an expanded program in which we review clinical criteria to determine if an imaging service requires a hospital-based outpatient setting, which offers a higher intensity of service resources, or if a free-standing imaging center is a clinically appropriate and available alternative. Using the patient’s clinical information that you submit, we conduct a clinical appropriateness review of your advanced imaging request against our evidence-based clinical guidelines or your patient’s health plan medical policy. * Echocardiography may also be included in the scope of the Cardiology Solution Our Site of Care review process Transesophageal Echocardiography (TEE)*.Computed Tomography (CT), including CT angiography, derived fractional flow reserve, structural CT and quantitative evaluation of coronary calcification.Nuclear imaging, including myocardial perfusion imaging, cardiac blood pool imaging, infarct imaging and Positron Emission Tomography (PET) myocardial imaging.Providers benefit by having a central location to obtain authorizations required by your patients’ health plans.Ĭontact Carelon to obtain pre-service review for the following non-emergency services: The clinical information you submit is reviewed against Carelon clinical guidelines and health plan specific medical policies to ensure alignment with current best practices. Our Radiology review processĬarelon is here to assist in your efforts to deliver the best quality and affordable care for your patients. And that’s good news for your practice and your patients. Developed in collaboration with your patients’ health plans, our Radiology program helps support quality care that is consistent with current medical evidence and delivered in the most clinically appropriate setting. Carelon Medical Benefits Management understands the key role that medical practices play in the delivery of care for patients who require imaging studies.
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