Providers:
View list of CT and MRI providers.
Notification requirements:
- Patients are strongly encouraged to notify The Alliance prior to the scan appointment. Go to www.qualitypath.com/tellus to submit your information. Notification is not required to receive QualityPath benefit levels for CTs and MRIs.
Services covered at QualityPath level of benefits:
- Services performed by the QualityPath provider during the patient medical service encounter, including but not limited to:
- The CT or MRI and related services on a non-emergent, outpatient basis. The image must be the primary purpose for the encounter. (See the section “Triggering Service Codes” below for the list of eligible non-emergent outpatient CTs and MRIs.)
- Drugs, biologicals, and radiopharmaceuticals that function as supplies and contrast agents and are administered by the QualityPath provider
- All supplies
- Ancillary services performed by the QualityPath provider
- Guidance service
- Image processing services
- Observation services
- Image reading and interpretation
Warranty:
Services under the warranty are covered under the QualityPath level of benefits. The warranty period begins the day of the scan and covers the following:
- Reimaging, due to image quality, of the same site of service Triggering Service Code within 30-days when both episodes are provided by the same QualityPath designated provider.
Patient requirements to maintain the warranty include:
- Receiving all reimaging from the QualityPath provider.
- Contact the patient experience manager at The Alliance at 800.223.4139 if your doctor asks for the scan to be redone because of the quality.
Exclusions:
The following services are not eligible for the QualityPath level of benefits. Check with your benefits administrator for coverage levels under the standard health plan benefits.
- Emergent or inpatient care
- When the image is performed as part of a surgical procedure or other more comprehensive service
- Certain Specialized Imaging—those that may require special equipment in addition to CT/MRI machine, including:
- Breast MRI
- Cardiac MRI
- Cardiac CT
- All services provided by a non-QualityPath provider including but not limited to the administration of contrast materials.
- Services provided by a QualityPath provider performed prior to member’s enrollment in the program
