The American College of Radiology (ACR) has created a web resource page to help its state chapters and individual members with local advocacy efforts to address Anthem Blue Cross/Blue Shield’s new preauthorization requirements for hospital-based CT and MRI.
In selected states, Anthem now requires a “medical necessity” review prior to authorization for CT and MRI performed in hospital-based settings. Procedures that fail the insurer’s medical necessity test are denied, and patients are directed to authorized, alternative freestanding imaging services to fulfill the physician’s order.
ACR members can use downloadable resources on the resource page to describe the policy’s adverse effects on patient care to lawmakers, regulators, government officials and the media. They include template letters to lawmakers, background materials and a repository of media coverage to date.
Anthem has enacted its controversial policy in Colorado, Indiana, Kentucky, Missouri, Wisconsin, Ohio, Nevada, Georgia and New York state. Implementation in California has been delayed until December, and is planned for Connecticut, Maine and Virginia beginning on March 1, 2018.
Anthem will start retroactive reviews of MRI and/or CT services done in emergency departments in Missouri, Ohio and Kentucky on Nov. 15. It will deny imaging claims if it decides the case was not truly an emergency.