Radiology Solution

View high-tech exams in a new light

Our Radiology Solution helps reduce your health plan’s spending and your members’ exposure to unnecessary radiation by promoting evidence-based imaging. Our efficient review workflow helps ensure accurate and timely diagnoses, even at the point of care. When clinically appropriate, we proactively engage your members to recommend high-value outpatient imaging centers.

Lines of business

•  Commercial
•  Medicare
•  Medicaid
•  Federal employee

curved lines graphic

Picture the impact of clearer imaging decisions

When your members need advanced imaging, our streamlined evidence-based clinical review guides providers to better choices. With our solution available to your provider networks, the right clinical decisions become clearer, and that helps everyone.

Help protect your members from health risks and costs

Advanced imaging is a widely utilized service. And it can present real risks for your members, like exposure to radiation and high out-of-pocket costs. We help ensure that your members aren’t exposed to either if it’s not clinically necessary.



Make evidence-based imaging the norm

Whether out of habit, eagerness to use new technologies, or difficulty keeping up with the high volume of available research, many providers order advanced imaging when the latest clinical criteria suggest otherwise. We help make sure that your providers order advanced imaging only when the latest proven evidence calls for it.



Move services to affordable settings

Many members undergo imaging at costly settings, like hospitals, when there’s little clinical benefit to that site. We help redirect imaging to where it makes sense. With our solution, your health plan reimburses for services at high-performing, high-value outpatient centers when appropriate. 



Inside our Radiology Solution

Reducing waste within radiology requires a comprehensive approach. And that’s how we built our solution.

Clinical appropriateness review

Clinical setting optimization (optional)

Practice engagement resources

EMR integration (optional)

Member engagement (optional)

Advanced analytics and reporting

How our solution works

Your providers submit requests to us online or over the phone.

Our automated platform reviews requests in real time.

Requests meeting clinical criteria are immediately approved. Our clinical reviewers, including board-certified radiologists and nurses, are available to consult with your providers about any requests that don’t meet our clinical criteria. 

We redirect imaging services to high-value sites of care, when clinically appropriate. (Optional)

Request data is shared with your system(s) for claims, care management, and/or reporting purposes.

Ask us about our Radiology Solution

Health plan leaders, contact us to learn more about the possibilities and impact of our Radiology Solution.

Are you a health plan member?

If you’re a health plan member and have a question about your health plan, please call the member services number on the back of your health plan ID card.

Provider inquiries

For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team 

Business hours: 8:00 a.m. – 5:00 p.m. CST.