Collaborations · For Payors
Outpatient Imaging Solutions for Payors
Where quality meets cost. RadNet performs 12 million+ procedures annually and accepts referrals from hundreds of sources, with the geographic reach and contracting flexibility payors require.
Plan participation
RadNet participates across plan and payment types.
Utilization management
Under some capitated contracts with IPAs and medical groups, RadNet’s Utilization Management division reviews imaging orders for medical necessity and appropriateness. Its board-certified and licensed clinicians review nearly 300,000 cases annually.
Referral guidance helps direct imaging to cost-effective, free-standing outpatient centers, and referring physicians receive education on the medical necessity of the studies they order.
How Authorization Works
Your benefit manager reviews the request. RadNet performs and bills the exam once the authorization is on file.
The order
The referring physician orders the exam and sends the clinical documentation your benefit manager asks for: the order, history and physical, relevant notes, labs and any prior imaging.
Your review
For PPO exams, your radiology benefit manager reviews medical necessity against your guidelines. RadNet is not part of that review.
The approval
The authorization number and its expiration date are provided to RadNet for billing.
The exam
If the approval has not arrived before the appointment, the visit is rescheduled rather than performed without authorization.
What your members see: prior authorization explained in plain language on the Insurance and Authorization page.
Contracting and standards
RadNet supports a range of reimbursement models, with efficient mechanisms for contracting and payment. A network of 442 centers places outpatient imaging where plan members live and work, and many centers deliver care in multiple languages.
RadNet holds its centers to national standards, supported by a formal quality assurance and compliance program and center productivity benchmarking with extensive reporting.
Talk to network development
For plan participation and contracting inquiries, contact the team for your region.
Senior Vice President, HealthCare Network Strategy & Business Development
charlie.shaw@radnet.com
Senior Vice President, Contracting & Network Strategy
terri.herrick@radnet.com
Join the network
Appropriate, cost-effective imaging across a national footprint.