Radiology utilization for Arkansas Blue Cross FEP

Vendor monitors use of diagnostic imaging for our members

Carelon Medical Benefits Management operates the Radiology Utilization Management Program on behalf of Arkansas Blue Cross and Blue Shield’s Federal Employee Program (FEP).

Carelon handles medical necessity review of diagnostic imaging services for FEP members.

Carelon works with leading insurers and providers, through evidence-based practice initiatives, to improve healthcare quality and manage costs for today’s most complex and prevalent tests and treatments, helping to promote care that is appropriate, safe and affordable.

All providers must contact Carelon to obtain pre-service review for the following nonemergency modalities:

• Nuclear imaging (including myocardial perfusion imaging), cardiac blood pool imaging, infarct imaging and positron emission tomography (PET) myocardial imaging.
• Computed tomography (CT), including CT angiography, structural CT and quantitative evaluation of coronary calcification.
• Magnetic resonance imaging (MRI).
• Magnetic resonance angiography (MRA).
• Magnetic resonance spectroscopy (MRS).
• Functional MRI (fMRI).

How to submit a request for review:

Providers may submit requests for review or verify order numbers, using one of the following methods:

• Online: Through a fully interactive Carelon ProviderPortal^SM (available 24/7). This portal processes requests in real-time, using clinical criteria. Register here.
• By phone: Call Carelon Medical Benefits Management toll-free at 866-688-1449 (7 a.m. - 7 p.m. Central, Monday - Friday).

For more information:

• Online: Providers may access Radiology Utilization Management Program resources on the Carelon provider website that also has more information about the program and provides access to useful information and tools such as order entry checklists and clinical guidelines. Providers can also find more about Carelon online.
• By phone: Providers who have questions or observations may contact their designated Arkansas Blue Cross representative.

Arkansas Blue Cross and Blue Shield’s FEP Employee Program greatly values the trusted healthcare providers that serve the members who depend on us for their health coverage, and we look forward to working with you and Carelon to maintain a high standard of care.

Note: Carelon Medical Benefits Management is an independent company that operates separately from Arkansas Blue Cross and Blue Shield and administers radiology utilization management services for the benefit of Arkansas Blue Cross Federal Employee Program members. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross Blue Shield Association.