Radiology Solution
View high-tech exams in a new light
Our Radiology Solution helps reduce unnecessary radiation exposure while helping your health plan manage imaging costs. Radiology benefit management helps support appropriate use of imaging services such as MRI, CT, and PET scans through evidence-based guidelines and prior authorization. Our efficient review workflow helps providers make timely, informed imaging decisions — even at the point of care. When clinically appropriate, we proactively engage members and providers to recommend high-value outpatient imaging centers.
Lines of business
- Commercial
- Medicare
- Medicaid
- Federal employee
Picture the impact of clearer imaging decisions
When your members need advanced imaging, our streamlined clinical review helps providers make evidence-based decisions. The result is a more consistent approach to appropriate imaging, supported by clinical expertise and clear criteria.
Help protect your members from health risks and costs
Advanced imaging can play an important role in diagnosis and treatment planning. However, when advanced imaging is not clinically necessary, it can add avoidable costs and potentially unnecessary radiation exposure. Our radiology utilization management can help reduce both.
Make evidence-based imaging the norm
Clinical evidence continues to evolve, making it challenging to stay current across every imaging scenario. We give providers access to evidence-based criteria and clinical review that help support consistent, appropriate advanced imaging decisions.
Support high-value sites of care
Many members undergo imaging at costly settings, like hospitals, when there’s little clinical benefit to that site. Our radiology benefits management can help identify appropriate sites of care based on clinical needs. With our solution, your health plan reimburses for services at high-performing, high-value outpatient centers when appropriate.
What’s included in our Radiology Solution
Supporting appropriate, cost-effective imaging takes a comprehensive approach. And that’s how we built our solution. We bring together clinical expertise, technology, engagement, and insights to put that approach into practice.
Clinical appropriateness review
Clinical setting optimization (optional)
Practice engagement resources
EMR integration (optional)
Member engagement (optional)
Advanced analytics and reporting
How radiology management and utilization review works
Request
Your providers submit requests to us online or by phone.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Determine
Requests that meet clinical criteria can be approved immediately. When additional review is needed, our clinical reviewers, including board-certified radiologists and nurses, are available to consult with your providers about requests that don’t meet our clinical criteria or the health plan’s medical policy.
Redirect
When clinically appropriate, we can redirect imaging services to high-value sites of care. This capability is optional.
Synchronize
We share request data with your system(s) for claims, care management, or reporting purposes, as applicable.
Ready for the next step?
Connect with us to explore the potential impact of our Radiology Solution for your health plan.
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Frequently asked questions about radiology solutions
Are you a health plan member?
If you’re a health plan member and have a question about your health plan, please call the Member Services number on the back of your member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 800-252-2021 or contact our support team .
Business hours: 8 a.m. to 5 p.m. CT.