Imaging Vendor Guidelines

 

As of 1/1/2025, our imaging vendor will be changing from eviCore to HealthHelp. Please see guidelines and helpful information below for both vendors.

 

HealthHelp - Authorizations submitted after 1/1/2025

Cardiology, radiology, and musculoskeletal services authorization requests are submitted to HealthHelp via NaviNet or by calling 1-844-325-6251 (Medicaid) or 1-833-841-8075 (DSNP Medicare).

  • Log into NaviNet
  • Select Highmark Health Options as the Health Plan

Select HealthHelp from Workflows for this Plan

Representatives are available 8 a.m. to 4:30 p.m., Monday - Friday. TTY users call 711. Services requiring authorization in less than 48 hours due to medically urgent conditions should be submitted online or over the phone. Providers must indicate that the procedure is not routine or standard.

Prior to the authorization request, gather all relevant clinical information related to the condition and available at the time of request:

  • Physician exam notes
  • Results of relevant tests
  • Lab results
  • Prior imaging and X-ray reports
  • Patient history
  • Physical findings
  • Signs and symptoms
  • Office visits

 

eviCore - Authorizations submitted before 1/1/2025

Cardiology, radiology, and musculoskeletal services authorization requests are submitted to eviCore at evicore.com or by calling 1-888-564-5492, 7 a.m. – 7 p.m. Services requiring authorization in less than 48 hours due to medically urgent conditions should be submitted online or over the phone. Providers must indicate that the procedure is not routine or standard.

Prior to the authorization request, gather all relevant clinical information related to the condition and available at the time of request:

  • Physician exam notes
  • Results of relevant tests
  • Lab results
  • Prior imaging and X-ray reports
  • Patient history
  • Physical findings
  • Signs and symptoms
  • Office visits

For more information about eviCore, review the Quick Reference Guide.

© Highmark Inc. All rights reserved.

Blue Cross, Blue Shield, and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield Plans.Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield is an independent licensee of the Blue Cross Blue Shield Association.

Highmark Health Options Duals is offered by Highmark Blue Cross Blue Shield. Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal. All references to “Highmark” on this website are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.