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  • HIP Outpatient Diagnostic Imaging Referral Payment Policy

    Our diagnostic imaging payment policy as it applies to services performed in an office setting (POS 11). The policy designates which imaging procedures will be reimbursed (subject to the member’s benefit plan) according to practitioner specialty.

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    Glossary terms found on this page:

    A health insurance product offered by a health plan company that is defined by the benefit contract and represents a set of covered services. Also called a health benefit plan.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.

    A recommendation by a physician that an enrollee receive care from a specialty physician or facility.

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