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Evolent

NH Healthy Families has partnered with Evolent for the management of advanced imaging, diagnostic cardiology, interventional pain, musculoskeletal surgery, and physical medicine services.

Evolent specializes in connecting care for people with complex conditions through collaborative relationships with physicians and payers. The decision to implement this program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage increasing utilization of these services. NH Healthy Families oversees the Evolent program and is responsible for claims adjudication.

Prior authorization is required through Evolent for the following non-emergent outpatient services:

  • CT/CTA
  • MRI/MRA
  • PET Scan
  • MUGA Scan
  • CCTA
  • Myocardial Perfusion Imaging (MPI)
  • Echocardiography
  • Stress Echocardiography 
  • Cardiac Implantable Devices (defibrillator, pacemaker)
  • Left Heart Catheterization
  • Interventional Pain Management
  • Musculoskeletal Surgery – Inpatient & Outpatient (Hip, Knee, Shoulder, Lumbar & Cervical Spine)
  • Physical Medicine (Physical, Occupational, and Speech Therapy)

KEY PROVISION: Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim.

Please go to RadMD.com for additional details about Evolent programs, including clinical guidelines and prior authorization requirements.