As of Jan. 1, 2017, CT and MRI is a part of the QualityPath program. To better inform our QualityPath participating providers of eligible enrollees in the program we are distributing QualityPath program cards.

We hope this will help providers identify who is eligible for QualityPath, since those patients typically have no co-pays.

The program card will look like this –

qualitypath program card

Providers will be able to identify QualityPath patients in one of three ways:

  • Through the QualityPath program card that patients may present along with their insurance ID card.
  • By referring to the list of employers that have QualityPath, available on our website.
  • By contacting our Customer Service Department at 800.223.4139

Additional Reminders about QualityPath

  • QualityPath services are allowed at 100 percent (HSA plans may have some upfront patient portion) thereby eliminating the need to collect patient copays up front.
  • QualityPath CT and MRI include images performed on a non-emergent outpatient basis where the image is the primary purpose for the encounter and the patient is eligible for QualityPath benefits.
  • For your reference, below are QualityPath CT and MRI triggering codes.
  • Follow your current billing structure (1 global claim or 1 technical and 1 professional). Bill all services on the same claim for the patient encounter. Do not include services on the claim that are not part of the QualityPath bundle.
  • The QualityPath episode includes a 30-day warranty due to image quality, where triggering service codes within 30-days of the initial image by the same provider and same triggering code are included in the episode reimbursement. Our system will review claims prior to repricing to identify possible warranty claims. If there is a possible warranty claim, we will contact you for clarification.

 

Triggering Service Codes

MRI with Dye 70542,70543,70545,70546,70548,70549,70552,70553,70558,70559,71551,71552,71555,72142,72147, 72149,72156,72157,72158,72196,72197,73219,73220,73222,73223,73719,73720,73722,73723,73725, 74182,74183,74185,C8900,C8902,C8909,C8911,C8912,C8914,C8918,C8920,C8934,C8936

MRI without Dye 70336,70540,70544,70547,70551,70557,71550,72141,72146,72148,72195,72198,73218,73221,73225, 73718,73721,74181,C8901,C8910,C8913,C8919,C8935

CT without Contrast 70450,70480,70486,70490,71250,72125,72128,72131,72192,73200,73700,74150

Level 1 CT with Contrast 70460,70470,70481,70482,70487,70488,70491,70492,70496,70498,71260,71275,72127,72129,72130, 72133,72191,72193,72194,73202,73206,73701,73702,73706,74160,74170,74175,75635

Level 2 CT with Contrast 71270,72126,72132,73201,74174,74177,74178

CT Abdomen & Pelvis without Contrast 74176

Contact us:
Please let us know if you have any questions or if you would like to learn more about QualityPath. Contact provider services at 800.223.4139 or email providerservices@the-alliance.org.

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