Advanced and Cardiac Imaging
Provider Type
- Physicians
Health Net partners with Evolent Specialty Services, Inc. (Evolent), to provide utilization management (UM) services, including prior authorization determinations for certain advanced and cardiac imaging for fee-for-service Medi-Cal members.
Prior Authorization Requirements
The following outpatient procedures require prior authorization from Evolent, with the exception of emergency room, urgent care, and observation setting for advanced and cardiac imaging:
- Advanced imaging:
- Computed tomography (CT)/computed tomography angiography (CTA)
- Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA)
- Positron emission tomography (PET) scan
- Cardiac imaging:
- Coronary computed tomography angiography (CCTA)
- Myocardial perfusion imaging (MPI)
- Multigated acquisition (Muga) scan
Prior Authorization Requests
Prior authorization requests must be submitted to Evolent online or by telephone as follows. Evolent does not accept fax submissions.
- Online - Post-log in at www.RadMD.com, 24 hours a day, 7 days a week, except when maintenance is performed once every other week after business hours.
- Evolent, available Monday through Friday, from 8 a.m. to 8 p.m.
Expedited authorization requests may only be submitted by telephone.
To expedite the request process, providers must have the following information ready before logging in to the Evolent website or calling (*denotes required information):
- Name and office telephone number of ordering provider*
- Member name and identification (ID) number*
- Requested examination*
- Name of provider office or facility where the service will be performed*
- Anticipated date of service (if known)
- Details justifying the examination*
- Symptoms and their duration
- Physical exam findings, including findings applicable to the requested services, conservative treatment the member has already completed (such as physical therapy, chiropractic or osteopathic manipulation, hot pads, massage, ice packs, and medication)
- Results and/or reports of preliminary procedures already completed (such as X-rays, CTs, lab work, ultrasound, scoped procedures, referrals to specialist, and specialist evaluation)
- Reason the study is being requested (such as further evaluation, rule out a disorder)
The following information may also be requested:
- Clinical notes
- Reports of previous procedures
- Specialist reports/evaluation