Evolent Specialty Services

Magnolia Health has contracted with Evolent Specialty Services for radiology benefit management.

The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Magnolia Health oversees the Evolent program and is responsible for claims adjudication. Evolent manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities.

Prior authorization is required for the following outpatient radiology procedures:

• CT/CTA/CCTA
• MRI/MRA
• PET Scan

KEY PROVISION:

Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim.

Go to the Evolent website for more information.

Prior Authorization

To obtain a prior authorization, go to the Evolent Website, www.RadMD.com.

To obtain a prior authorization for Nuclear Studies, call 1-866-912-6285.

• Tip Sheet for Ordering Advanced Imaging Studies (PDF)
• Steps for Imaging Prior Authorizations (PDF)

RadZone Kids

RadZone Kids is Evolent's newest community resource to support parents in educating their children about what to expect from certain diagnostic imaging tests. This innovative tool provides an interactive way for a child and parent to better understand and prepare for various radiology tests, including CT scans, MRI scans and X-rays. RadZone also encourages parents to talk with the physician regarding the risks and benefits of any imaging study, and discuss alternatives when appropriate.

www.radkids.org