Capital Blue Cross
Welcome to the Capital Blue Cross Health Plan page. Here you can access helpful information related to the program.
In keeping with our commitment of promoting continuous quality improvement for services provided to Capital Blue Cross members, Capital Blue Cross is expanding its partnership with Magellan Healthcare1effective August 1, 2019, to implement a Clinical Validation of Records (CVR) process.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager, Lori Fink.
Update on COVID-19
Radiology Benefit Management
Documents
- Capital Blue Cross Utilization Review Matrix-2021
- Capital Blue Cross Cardiac Expansion Training
- Capital Blue Cross Cardiac FAQ
- Capital Blue Cross Clinical Validation of Records QRG
- Capital Blue Cross CVR PPT - effective August 1, 2019
- Capital Blue Cross Peer-to-Peer Document
Cardiac Expansion
Capital Blue Cross Cardiac Expansion Recording
Radiation Oncology Management Educational
Documents
- Capital Blue Cross Radiology Oncology Utilization Review Matrix-2021
- Frequently Asked Questions For Radiation Oncologists and Cancer Treatment Facilities
- Radiation Oncologists and Cancer Treatment Facilities Quick Reference Guide
- Radiation Oncology Provider Training Program
- Radiation Therapy Treatment Form
Radiation Oncology Checklists
- Anal Cancer
- Bone Metastatic Cancer
- Bone Primary Cancer
- Breast Cancer
- Central Nervous System (CNS) Metastatic Cancer (Brain/Spine)
- Central Nervous System (CNS) Primary Cancer (Brain/Spine)
- Cervical Cancer
- Colon
- Endometrial Cancer
- Gastric Cancer
- Head and Neck Cancer
- Hodgkins Lymphoma
- Lung Cancer (Non-Small Cell)
- Lung Cancer (Small Cell)
- Non-Hodgkins Lymphoma
- Pancreas Cancer
- Prophylactic Cranial Irradiation
- Prostate Cancer
- Rectal
- Skin Cancer
- Other Cancer
- Other Metastatic Cancer
NIA Radiation Oncology Coding Standards - Effective 1/1/2022
- Dosimetry Planning Coding Standard
- Image Guidance Coding Standard
- Physician Treatment Management Coding Standard
- Physics Coding Standard
- Simulation Coding Standard
- Treatment Devices Coding Standard
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.