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Privileging Application and Requirements

Highmark Blue Cross Blue Shield Delaware, with the assistance of National Imaging Associates, Inc. (NIA), an affiliate of Magellan Health, Inc., has implemented a new imaging privileging process.

On this page you will find Highmark Delaware's privileging requirements and online application instructions.

Process for Completing a Privileging Application

If you perform diagnostic imaging services and would like to apply to become a privileged provider, you must complete the online Highmark Delaware Privileging Application.
You will need to contact NIA at 1-888-972-9642 or send an e-mail to RADPrivilege@Magellanhealth.com to obtain a login for the application. (Each diagnostic imaging location will require a separate application and login.) NIA will need the following information in order to assign a login.

  • Provider name
  • Address of diagnostic imaging location
  • Tax identification number

Privileging Appeal Process

Highmark Delaware requires that all network providers comply with the terms and conditions of their contracts and meet the applicable requirements for performing imaging services. Highmark Delaware has established privileging requirements for providers who bill for imaging services in an outpatient setting.

Highmark Delaware provides an appeal process for Highmark Delaware Privileging Application denials. The following outlines the procedure for provider appeals of Highmark Delaware Privileging Application denials:

  1. Written appeals must be requested in writing within 60 days of receiving a denial letter.
  2. Appeals should be submitted on letterhead that indicates the provider name, and includes the billing provider number and tax ID number of the provider/location that has been denied privileges.
  3. Documentation supporting the request for an exception to the Requirements or reason why the decision was incorrect should be included.
  4. Appeals and accompanying documentation should be faxed to 866-552-7589 (This fax number is intended for NIA Magellan application appeals only. Claim denial appeals should NOT be faxed to this number).

The Highmark Delaware Privileging Appeal Hearing Panel will review all submitted documentation and issue a written decision that includes a statement of the basis for the decision, within 60 days of receipt of your appeal.

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Last updated on 12/17/2018 8:09:10 AM

 

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Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.