Capital Blue Cross
Welcome to the Capital Blue Cross Health Plan Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Lori Fink.
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 Healthcare1 effective August 1, 2019, to implement a Clinical Validation of Records (CVR) process.
Advanced Imaging Program
- Utilization Review Matrix-2022
- Cardiac Expansion Training
- Cardiac FAQ
- Clinical Validation of Records QRG
- CVR PPT
- Peer-to-Peer Document
Radiation Oncology Management Educational Documents
- Radiology Oncology Utilization Review Matrix-2022
- 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
- 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
- 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
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
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
- 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.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).