Horizon Echocardiography Privileging Program

CareCore National Announces the Implementation of Echocardiography Privileging and Credentialing Standards for Horizon BCBS

The high utilization with geographic variation and 8-10% annual growth of transthoracic and stress echocardiography pose a great concern regarding the quality of the procedures being performed.

Recognizing these issues, the American College of Cardiology (ACC) and the American Society of Echocardiography (ASE) have published training and accreditation standards to assure that echocardiography procedures are not only performed for appropriate indications but are also performed by professionals meeting the training standards agreed upon in the ACC 2003 Clinical Competence Statement on Echocardiography and at sites accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).

Working through CareCore National, Horizon BCBS has taken an industry leading role in the implementation of these national standards in an effort to assure the delivery of superior quality echocardiography for its membership. This effort, along with the use of a evidence-based prior authorization program for transthoracic and stress echocardiography, will enhance patient care by delivering appropriate procedures.  Further, it will avoid redundancy due to unnecessary repetitive testing attributed to poor procedure quality.

This Horizon Echocardiography Privileging Program will begin on November 30, 2009. All sites desiring to perform transthoracic and stress echocardiography will require ICAEL accreditation. Sites supervised by a board certified cardiologist must meet this requirement by November 30, 2010. The performance and interpretation of these studies will be limited to providers who are board certified in cardiology by the American Board of Internal Medicine (ABIM), American Board of Pediatrics (ABP) or providers certified by the National Board of Echocardiography (NBE) for transthoracic echocardiography and/or stress echocardiography. Any echocardiography procedures performed at sites not accredited by ICAEL and/or by providers who are not ABIM/ABP certified in cardiology or NBE certified may not be reimbursed regardless of the medical necessity of the procedure.

Participation in the Horizon Echocardiography Privileging Program is required to be privileged to perform, interpret, and receive reimbursement for transthoracic and stress echocardiography procedures, providers will need to submit an application with supporting documentation fulfilling the above criteria to CareCore National’s Credentialing Department. An application may be downloaded from CareCore National’s website at www.carecorenational.com/PDFS/HorizonEchoApp.pdf.

Applications can be mailed to:
CareCore National
Attn: Credentialing Dept.
400 Buckwalter Place Boulevard
Bluffton, SC 29910

Applications can also be faxed to 845-298-8384. We encourage that all qualified sites submit completed applications at least two weeks before November 30, 2009 to assure inclusion as a privileged site.

For commonly asked questions regarding the Horizon Echocardiography Privileging Program for transthoracic and stress echocardiography, click here.