HealthPlus and our
physician network have successfully worked with CareCore National (CCN) for
over six years to ensure the safety and quality of high-tech imaging services
to our mutual members and patients.
In the effort to expand
upon this initiative, enhancements which focus on low-tech imaging services in
the physician office are being introduced through the CCN Low-Tech (In-Office)
Imaging Quality Management Program.
What is the Low-Tech (In-Office)
Imaging Quality Management Program?
For imaging services not
requiring pre-certification, HealthPlus believes that accredited radiology
facilities should be used to ensure that the technical and professional
components of all diagnostics are of the highest quality. We also
recognize that in order to appropriately diagnose and treat members in a timely
manner, there are instances in which it is appropriate for some imaging to
occur in the physician’s office.
HealthPlus allows certain
CPT codes to be billed to HealthPlus by the treating physician. It is our
expectation that imaging performed in the physician’s office meets certain professional
Through the CCN Low-Tech
(In-Office) Imaging Quality Management Program, CCN will begin collecting
information obtained through the Professional Physician Practice Assessment
(PPPA) tool. This tool is used to review and ensure the quality of low-tech
imaging services provided in the offices of HealthPlus physicians.
If you provide low-tech imaging
services in your office, what should you do?
For questions about the
PPPA submission, contact CCN at 1-800-918-8924, ext 10190, Monday - Friday,
8:30 a.m. to 5 p.m. or via the CareCore National website.
What low tech imaging services are
included in the Low-Tech (In-Office) Imaging Quality Management Program?
Is prior authorization required for
low-tech in-office imaging services?
Prior authorization is not
required for the following imaging services:
Why is HealthPlus implementing this
quality program and who will be impacted?
HealthPlus is implementing
this program to ensure the safety and quality of low-tech imaging services
rendered in the physician’s office. This program will primarily impact primary
care and some specialist physicians who provide the imaging services listed
What will CCN review if a site visit
If CCN conducts an onsite
review of your practice (with consent from HealthPlus), the following
components will be assessed during the visit:
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