Patients covered by BCNEPA health plans will begin transitioning to Highmark health plans as of Jan. 1, 2016. You can verify these patients’ benefits using Highmark NaviNet’s Eligibility and Benefits transaction, and then selecting Eligibility and Benefits Details (see chart below). However, some patients will remain in BCNEPA health plans well into 2016. You can continue to verify these patients’ benefits using BCNEPA NaviNet’s Eligibility and Benefits Details. Providers who do not currently have NaviNet access should call Provider Relations at 1-800-451-4447 to obtain access. Information pertaining to Privileging Requirements is also available on the Highmark Radiology Management Services page. However, privileging requirements are not changing at this time. Keep checking future issues of Provider Bulletin for more information as details become available. Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt As you know, both Blue Cross of Northeastern Pennsylvania and Highmark require prior authorization of high-tech outpatient radiology services. These services are provided by National Imagining Associates, Inc. (NIA). It’s important to know that the radiology management services provided by NIA to BCNEPA members differ from the services provided by NIA to Highmark members. Radiology Management Services Changes Effective Jan. 1, 2016 Certain groups may choose to opt out of these management programs. Always check Benefits and Eligibility in NaviNet to determine if a group follows the Advanced Imaging, Radiation Therapy or Physical Medicine Management programs.

Radiology Management Services Changes Effective Jan. 1, 2016 · Radiology Management Services Changes Effective Jan. 1, 2016 Certain groups may choose to opt out of these management

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Page 1: Radiology Management Services Changes Effective Jan. 1, 2016 · Radiology Management Services Changes Effective Jan. 1, 2016 Certain groups may choose to opt out of these management

Patients covered by BCNEPA health plans will begin transitioning to Highmark health plans as of Jan. 1, 2016. You can verify these patients’ benefits using Highmark NaviNet’s Eligibility and Benefits transaction, and then selecting Eligibility and Benefits Details (see chart below).

However, some patients will remain in BCNEPA health plans well into 2016. You can continue to verify these patients’ benefits using BCNEPA NaviNet’s Eligibility and Benefits Details.

Providers who do not currently have NaviNet access should call Provider Relations at 1-800-451-4447 to obtain access.

Information pertaining to Privileging Requirements is also available on the Highmark Radiology Management Services page. However, privileging requirements are not changing at this time. Keep checking future issues of Provider Bulletin for more information as details become available.

Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt

As you know, both Blue Cross of Northeastern Pennsylvania and Highmark require prior authorization of high-tech outpatient radiology services. These services are provided by National Imagining Associates, Inc. (NIA).

It’s important to know that the radiology management services provided by NIA to BCNEPA members differ from the services provided by NIA to Highmark members.

Radiology Management Services Changes Effective Jan. 1, 2016

Certain groups may choose to opt out of these management programs. Always check Benefits and Eligibility in NaviNet to determine if a group follows the Advanced Imaging, Radiation Therapy or Physical Medicine Management programs.