ANTHEM BLUE CROSS BLUE SHIELD (Indiana, Kentucky, Ohio)
ANTHEM HEALTH PLANS OF VIRGINIA, INC. d/b/a
Anthem Blue Cross and Blue Shield and its HMO Affiliates (Virginia) [NEW - 4/2008]
BLUE CROSS BLUE SHIELD OF KANSAS CITY (Kansas City service area)
CARE CORE NATIONAL
HIGHMARK BLUE CROSS BLUE SHIELD (Western Pennsylvania)
OXFORD HEALTH PLANS
UNITED HEALTHCARE [NEWLY UPDATED - 1/15/2008]
UNITED HEALTHCARE Wisconsin

ANTHEM HEALTH PLANS OF VIRGINIA, INC. d/b/a
Anthem Blue Cross and Blue Shield and its HMO Affiliates

(VIRGINIA)
April 2008 - Anthem Health Plans of Virginia, Inc. d/b/a Anthem Blue Cross and Blue Shield and its HMO affiliates, released the following announcement:

• Accreditation requirements included to promote consistent, quality diagnostic imaging services
• Standards set by appropriate societal organizations have been adopted and will be utilized to establish a certification process for all imaging providers.
• Participating provider currently performing or conducting any CT, CTA, MRI, MRA, MRS, PET and/or Nuclear/Nuclear Cardiology studies shall obtain accreditation from the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) within one year of the effective date of this Agreement. Accreditation is required for each piece of equipment utilized in such studies no later than April 1, 2009.
• Participating provider not currently performing any CT, CTA, MRI, MRA, MRS, PET and/or Nuclear/Nuclear Cardiology studies, but at any point purchases or leases equipment and begins performing such studies, participating provider shall obtain accreditation from the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) for each piece of equipment utilized in such studies within one year of the date such studies are first conducted.
• Additional communication will follow on diagnostic imaging services, equipment, licensure and/or accreditation.

DIAGNOSTIC IMAGING SERVICES

Within 30 days of receipt of a written request, participating provider shall provide to Health Plan such information as may be requested concerning diagnostic imaging services, equipment, licensure and/or accreditation.

Providers that perform or conduct any CT, CTA, MRI, MRA, MRS, PET and/or Nuclear/Nuclear Cardiology studies shall be accredited by the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) for each piece of equipment utilized in such studies.

UNITED HEALTHCARE

NEWLY UPDATED, 1/15/2008 - UnitedHealth Group (UnitedHealthcare) has released an announcement requiring all freestanding imaging facilities and physician offices performing nuclear medicine, nuclear cardiology and PET procedures to apply for accreditation, and has extended its original deadline (3/1/2008) for this requirement until the third quarter of 2008. Please note: UnitedHealthcare has stated that freestanding imaging sites and/or provider clinics with imaging equipment who have not received accreditation by the above deadline, but have submitted their application to the ICANL, will be in a pending status and will be considered in compliance with the accreditation program.

Would you like to know more about the UnitedHealthcare requirement?
For the details and official guidelines from UnitedHealthcare, please visit their website section for Imaging Accreditation. [Go to UnitedHealthcareOnline.com > Clinician Resources > Radiology, and select Imaging Accreditation from the vertical menu bar on the left.] Get answers to common questions about the UnitedHealthcare policy in Imaging Accreditation: Frequently Asked Questions. >>

ANTHEM BLUE CROSS BLUE SHIELD

(INDIANA, KENTUCKY, OHIO)
June 2006 - Community Insurance Company d/b/a Anthem Blue Cross and Blue Shield in Ohio, Anthem Health Plans of Kentucky, Inc. d/b/a Anthem Blue Cross and Blue Shield in Kentucky, and Anthem Insurance Companies, Inc. d/b/a Anthem Blue Cross and Blue Shield in Indiana now accepts Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) from providers delivering nuclear cardiology, nuclear medicine and PET imaging services. In addition they accept Intersocietal Commission for the Accreditation of Magnetic Resonance Laboratories (ICAMRL) from providers delivering MRI services.

BLUE CROSS BLUE SHIELD OF KANSAS CITY

(BCBSKC)
March 2006 - Blue Cross Blue Shield of Kansas City (BCBSKC) has introduced a radiology privileging criteria program to practitioner groups within its service area, stating that "criteria implementation to all practitioner group sites will enhance service quality and safety of the diagnostic imaging studies delivered to our members and your patients." The objective of BCBSKC's privileging program is to "facilitate and promote an interrelated group of operational and professional criteria to ensure that practitioner groups providing CT, MR, plain film and PET services to membership are equipped and proficient to extend quality-driven service, technologically sound delivery and expertise within a safe and efficient environment."

Read the official guidelines. >>

HIGHMARK BLUE CROSS BLUE SHIELD

(PENNSYLVANIA)
In a July 13, 2004 letter to providers, Highmark Blue Cross Blue Shield announced that, effective January 1, 2005, all providers of diagnostic imaging services performed outside of a hospital setting will be required to adhere to new privileging guidelines. As detailed below, guidelines now exist related to each of the accrediting bodies within the Intersocietal Accreditation Commission: the ICANL, the ICAEL and the ICAVL.

According to Augusta L. Kairys, Vice President of Provider Relations for Highmark Blue Cross Blue Shield, "These guidelines have been developed to promote reasonable and consistent quality and safety standards for the provision of imaging services." The new privileging guidelines apply to most Highmark health plans in Western Pennsylvania (29 counties). Highmark plans to implement the program in Central Pennsylvania (21 counties) at a later date. Highmark has signed an agreement with National Imaging Associates, Inc., a national radiology management company, to help implement the program.

View the new Highmark Privileging Guidelines. >>

Read the Highmark Blue Cross Blue Shield press release. >>

CARE CORE NATIONAL

Outpatient diagnostic imaging utilization management company for HIP, Aetna and GHI requires all Nuclear Cardiology laboratories to be accredited effective February 2, 2004. For more information, visit the Care Core National website.

UNITED HEALTHCARE

(WISCONSIN)
Effective July 1, 2003, Wisconsin is the first state to link reimbursement to accreditation, according to a policy by United Healthcare of Wisconsin. The full story appears in the ICANL Newsletter article, Wisconsin To Require ICANL Nuclear Cardiology Accreditation, Fall 2000.

OXFORD HEALTH PLANS

It is important to note that Oxford Health Plans requires its nuclear cardiology laboratories to be accredited by either the ICANL or the ACR to receive reimbursement for nuclear cardiology claims. Oxford Health Plans announced that all physicians must meet one of the following standards effective February 2, 2004 in order to be reimbursed for nuclear cardiology procedures:

1. Certified by the Certification Board for Nuclear Cardiology (CBNC)

2. Board certified in Nuclear Medicine by the American Board of Nuclear Medicine (ABNM)

3. Board certified in Radiology by the American Board of Radiology (ABR)

Get more information by visiting the Oxford Health Plans website, or from the ICANL Newsletter article, Oxford Health Plans Links Reimbursement To ICANL Accreditation, Summer 2002.