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09.00.46ax, High-Technology Radiology Services (Independence)
Effective date
Sep 19, 2026
Identified
Sep 20, 2026
Summary
Independence Blue Cross has delegated utilization management for high-technology radiology services (CT, CTA, MRI, PET, ultrasound, nuclear medicine) to Carelon Medical Benefits Management, effective 09/19/2026. Carelon will now determine medical necessity using their Advanced Imaging Clinical Appropriateness Guidelines and conduct site-of-care reviews for select outpatient services. The policy does not apply to emergency room, inpatient, or observation unit stays.
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What to do
Action · 6 steps
01By 09/19/2026: Billing team must implement the following changes.
02Establish new prior authorization workflow with Carelon Medical Benefits Management for all high-technology radiology services (CT, CTA, MRI, PET, ultrasound, nuclear medicine) performed in outpatient settings.
03Update billing software to route radiology authorizations to Carelon instead of Independence Blue Cross internal review.
04Train billing staff and providers to consult Carelon's Advanced Imaging Clinical Appropriateness Guidelines (available at https://guidelines.carelonmedicalbenefitsmanagement.com/current-radiology-guidelines/) for medical necessity determinations before submitting claims.
05Verify member benefits prior to service to confirm Carelon program applicability.
06Ensure clinical team understands that services not covered in Company policies OR Carelon guidelines will be denied as experimental/investigational.
If missed: Failure to obtain Carelon authorization will result in claim denials and potential patient balance liability.
Original notice
09.00.46ax, High-Technology Radiology Services (Independence)
medpolicy.ibx.com · Always check the source before changing claims.
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