The Company covers high osmolar contrast agents; however, they are are not eligible for separate reimbursement from the diagnostic or therapeutic procedure and are included in the reimbursement for the associated procedure. Participating providers may not bill members for this service.
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to, records from the professional provider's office, hospital, nursing home, home health agencies, and therapies, as well as test reports.
The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.