CHA News Article

Anthem Revises Advanced Imaging Policy
Expected to take effect Jan. 1

Anthem has revised its medical necessity policy for advanced radiologic imaging procedures performed in a hospital, addressing some of the concerns raised by hospitals and physicians. The revised policy would allow advanced imaging at the hospital if the patient has a chronic disease that is expected to require multiple imaging procedures in the course of treatment and received a prior image at the hospital. In addition, the revised policy would exempt patients with a known contrast allergy or who require imaging as part of a pre-operative or pre-procedure workup being performed at the hospital or affiliated site. Finally, the policy exempts advanced imaging procedures if performance outside of the hospital “would reasonably be expected to adversely impact or delay care.” The Department of Managed Health Care is expected to approve the revised policy. Anthem has previously indicated the policy will become effective Jan. 1, 2018. While the revised policy is less restrictive than originally proposed, CHA will work with Anthem and the department to address continued concerns.