New HIP Outpatient Imaging Self-Referral Payment Policy

Date Issued: 3/11/2013

Effective July 2013, EmblemHealth will implement a new Outpatient Imaging Self-Referral Payment Policy (SRPP) to replace the Radiology and Cardiology Imaging Privileging programs for plans underwritten by HIP. Prior approval rules will continue to apply where applicable.

This policy promotes appropriate use of diagnostic imaging by our network clinicians in an office setting (POS 11). SRPP designates the minimum accreditation and certification requirements for specific imaging procedures performed by designated provider specialties. Only clinicians who meet the requirements may be reimbursed for those services (subject to member benefits).

Accreditation Requirements and Submissions

To determine whether requirements have been met, network practitioners will be reviewed for active accreditation in national databases from the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) for echocardiography services, and the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) or the American College of Radiology (ACR) for nuclear medicine/nuclear cardiology services.

Note: As of October 1, 2012, EmblemHealth no longer manages the credentialing process for radiology and cardiology imaging accreditation and privileging. For questions about your current accreditation status for performing radiology procedures in your office or about updates to your accreditation certificate, please contact eviCore by one of the following methods:

To obtain information on accreditation requirements and instructions on how to submit an application for accreditation, please refer to the accrediting organizations below

American Board of Internal Medicine (ABIM) 
American Board of Nuclear Medicine (ABNM) 
American College of Radiology (ACR) 
American Osteopathic Board of Internal Medicine (AOBIM) 
Certification Board for Nuclear Cardiology (CBNC) 
Intersocietal Accreditation Commission (IAC) 
National Board of Echocardiography (NBE)

SRPP Exclusions
This policy does not apply to HIP members assigned to a Montefiore (CMO) or Health Care Partners (HCP) primary care physician or members assigned to one of our four physician group practices: Queens-Long Island Medical Group, Staten Island Physician Practice, Manhattan’s Physician Group and Preferred Health Partners. These members can be identified by their member ID card or by accessing member eligibility information on our Web site. Requirements for GHI, GHI HMO and Vytra members are not changing at this time.