Cardiology and Imaging
Payer Operations for Cardiology and Imaging Practices
Advanced imaging authorizations routed through utilization-management vendors, procedure and device approvals, benefits verification, claims follow-up, appeals, and credentialing, handled within your systems by Ellery’s U.S.-based team, with every clinical decision staying in your practice.
What lands on our desk
- Prior authorizations for echocardiography, nuclear stress testing, cardiac CT and coronary CT angiography, cardiac MRI, and vascular imaging, including submissions through radiology benefit managers and utilization-management vendors when required
- Authorizations for catheterization, ablation, device implantation, and other procedures scheduled in hospital or ambulatory settings, with facility coordination where required
- Payer requirements for cardiac rehabilitation, ambulatory and remote monitoring, and wearable monitoring services
- Pharmacy-benefit authorizations for specialty cardiovascular medications, including step-therapy and formulary-exception administration
- Eligibility and benefits verification, referral requirements, and patient-responsibility estimates ahead of testing
- Claims status follow-up, underpayment review, and payer correspondence for imaging, procedure, and monitoring claims
- Denial and appeal administration, including administrative preparation for physician peer-to-peer reviews
- Provider credentialing, CAQH maintenance, hospital privileging support, and payer enrollment
Administrative demands in cardiology and imaging
Cardiology payer work often spans both medical-benefit authorization and payer-specific utilization management. Advanced imaging and cardiology services may route through a payer’s own process or a delegated utilization-management vendor, with requirements that vary by plan and procedure. Catheterization, ablation, implanted devices, and other scheduled procedures can add facility, site-of-service, and documentation requirements, while ambulatory monitoring creates recurring coverage and claims workflows. A defined process that tracks the applicable payer channel, required documentation, determination, and scheduling status gives the practice one place to see where each request stands.
How a case runs here
Ellery Health Partners locates and organizes the documentation the payer’s published criteria require, flags anything missing to your coordinator, submits through the channel your practice approves, monitors status, completes routine payer follow-up, coordinates routine additional-information requests from the record, and records every action, reference number, and outcome in your system. If a request is denied, Ellery Health Partners records the payer’s stated reason, the deadline, and the directed next step, and administers the appeal where that is in scope.
What stays with your practice
Clinical decisions, medical necessity, prescribing decisions, diagnosis and procedure code selection, physician peer-to-peer reviews, provider signatures and attestations, and clinical answers to payer questions remain with your clinicians. When a payer asks a clinical question, Ellery Health Partners documents it and routes it to the contact you designate.
Get started with Ellery Health Partners
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.