- 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
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.
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
Triggering Service Codes: