At CDPHP, we are committed to maintaining high-quality, cost-effective health care for our members. As part of our ongoing efforts, we are introducing prior authorizations for high-tech radiology services—specifically MR, CT, and PET imaging. This initiative, affecting all lines of business, aims to ensure members receive appropriate tests at the right time and place.
Due to a regulatory approval delay, we are temporarily postponing the planned date (September 9, 2024) when these prior authorizations were to go into effect. A new effective date will be announced soon.
An Important Change for Improved Outcomes
Our comprehensive review of the health plan market highlighted a concerning trend: a significant increase in unnecessary high-tech radiology tests and treatments. By implementing prior authorizations, we aim to:
HealthHelp: The Right Partner for the Best Decisions
To facilitate this new process, we are teaming up with HealthHelp, a leader in specialty benefits management. HealthHelp will manage the approval process using evidence-based guidelines from the American College of Radiology, the Centers for Medicare & Medicaid Services (CMS), and other medical specialty societies.
Their innovative approach focuses on:
Their program is centered on achieving the best possible patient outcomes, which is achieved through collaborative discussions with providers. This results in a low denial percentage and mitigates provider and member abrasion.
20+ years of experience in clinical and care management
Academically affiliated with 30+ leading academic medical schools
Complete with Clinical Experts
Q. Will this prior authorization result in scheduling delays?
Timely care is crucial. The new system with HealthHelp is designed to minimize delays:
Q. What if the service isn’t approved? How will the member be notified?
In cases where services do not meet clinical criteria, CDPHP and HealthHelp work collaboratively with providers to find suitable alternatives.
Both the member and provider will receive written and verbal notifications, including information on appeal rights.
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