Update:
Blue Cross and Blue Shield of Minnesota and Blue Plus have entered a relationship with Nuance for the Institute of Clinical Systems Improvement (ICSI) sponsored HTDI automated decision support program. This change could impact the processes you currently follow today regarding data submission and pre-certification / pre- authorization decision support services for HTDI.

Key process changes

Effective November 1, 2011, ordering physicians will be required to use a decision support system as part of their process for elective, outpatient HTDI procedures.

• Physicians and clinic groups can implement the new RadPort software either in an Electronic Medical Record (EMR) integrated version or a web-based version.
• Physicians and clinic groups who currently use an alternative decision support program for HTDI may continue to do so until further notice.

All providers must continue to follow Medical and Behavioral Health Policies for selected HTDI procedures as summarized in the section below both before and after November 1, 2011.

For specific questions about Nuance’s RadPort software, or to schedule training and implementation of the tool, contact ICSI at (952) 814-7067 or htdi@icsi.org.

Imaging procedures included in the automated decision support HTDI program

The new program covers the following elective, outpatient HTDI procedures:

• Computed tomography and angiography (CT/CTA) scans
• Positron emission tomography (PET scans)
• Magnetic resonance imaging and magnetic resonance angiography (MRI/MRA) scans
• Nuclear cardiology scans
• Combinations of PET, CT, MRI, etc.

Medical and Behavioral Health Policies relating to HTDI

Commercial Products:
All providers must continue to follow current pre-certification / pre-authorization and investigative policies in the Medical and Behavioral Health Policy Manual for commercial products. The following procedures have coverage criteria, are subject to medical review and continue to require the standard pre-certification / pre-authorization process as noted:

• Computed tomography angiography (CTA) for evaluation of coronary arteries
• CT colonography (virtual colonoscopy) as a screening test for colorectal cancer
• (pre-certification / pre-authorization required)
• MRI of the breast (pre-certification / pre-authorization required EXCEPT in individuals with biopsy proven breast cancer).
• Positron emission tomography (PET)

Minnesota Government Programs:
All providers must continue to follow current prior authorization and investigative policies in the Medical and Behavioral Health Policy Manual for Minnesota Health Care Programs (MHCP) as defined in your Provider Service Agreement. The following procedures continue to require the standard pre-certification / pre-authorization process:

• MRI of the breast
• CT colonography (virtual colonoscopy) as a screening test for colorectal cancer
• Computed tomography angiography (CTA) for evaluation of coronary arteries, including coronary CT and EBCT for calcium scoring
• PET scans
• SPECT scans case by case review
• Capsule endoscopy

Non-Covered Procedures:
These procedures are not covered for either commercial or Minnesota Government Programs members:

• Computed tomography (CT) screening for coronary artery disease
• Full body CT scanning
• Spiral CT screening for lung cancer

Members covered by the program

To date, this program includes the following Blue Cross lines of business in the Minnesota service area and providers in surrounding counties in Wisconsin, South Dakota, North Dakota and Iowa:

• Blue Cross fully insured members
• A limited number of Blue Cross self-insured Minnesota members
• Blue Plus members enrolled in Minnesota Health Care Programs (MHCP)

The EMR integrated RadPort software or the web-based version will display the member's name if they are included under the HTDI program. (Blue Cross membership feeds to RadPort contain only members who are part of HTDI program, so if the member is not displayed in RadPort that member is not included.)

More information

Please refer to Provider Bulletin P15-11 for specific procedures related to this program or call provider services at (651) 662-5200 or 1-800-262-0820.