American imaging Management prior authorization

Blue Cross and Blue Shield of Texas (BCBSTX) is contracted with AIM Specialty Health to provide clinical appropriateness review and education for outpatient high-tech diagnostic imaging services. AIM®' provides a Radiology Quality Initiative (RQI) program for Blue Choice PPOSM members.

AIM's Provider Portal makes it easy for your office staff to enter an order for a high-tech diagnostic imaging exam via the web. The web-based Provider Portal gives you 24/7/365 access to the RQI (Radiology Quality Initiative), and to claims and eligibility information. Best of all, not only can you enter an order for an exam, but you can receive an RQI online in real time (as long as additional clinical information is not needed).

Other processing enhancements include:

• Diagnosis driven symptom listings
• Multiple symptom selection
• Expanded clinical indication for all specialties
• Facilitates data collection

To obtain a Blue Choice PPO RQI, just log in to AIM's Provider PortalSM and complete the online questionnaire that identifies the reasons for requesting the exam. When criteria are met, you will be given an RQI. If criteria are not met or additional information is needed, the case will be automatically transferred for further clinical evaluation, and an AIM nurse will follow up with your office.

Other online features include:

• Convenient access. No waiting. Available 24/7/365
• Location of radiology providers, in your patient's area, that are contracted with BCBSTX
• Reduction of phone time by allowing information to be retrieved via the web
• Confirmation that an RQI has been issued through the RQI feature
• Online CPT Groupers and Clinical Guidelines are available

Included Products

Blue Choice (Includes Blue Choice PPO, EPO & FEP)

Blue Choice PPO physicians or professional providers must contact AIM first to obtain an RQI when ordering or scheduling the following outpatient diagnostic imaging services when performed in a physician's/professional provider's office, or the outpatient department of a hospital, or a freestanding imaging center: CT/CTA, MRI/MRA, SPECT/Nuclear Cardiology studies or PET scans*. Please note that facilities cannot obtain an RQI from AIM on behalf of the ordering physician. Also, the RQI program does not apply to Medicare primary members with BCBSTX Medicare supplement. Medicare Primary members with BCBSTX commercial PPO coverage are included in the program.

Note: For BlueCard subscribers, please contact Customer Service utilizing the phone number on the back of the subscriber's ID card to determine if the RQI program applies.

Other Options for Obtaining an RQI Number

RQI Checklist

(Required Information for the RQI Requests)

Please utilize the checklist below as a guideline to ensure you have all the necessary information prior to requesting an RQI from AIM:

• Subscriber's/Member's identification number, name, and date of birth
• Ordering physician's or professional provider's name, address, and telephone
• Imaging provider information (name, location)
• Imaging exams being requested (body part, right, left, or bilateral)
• Patient diagnosis (suspected or confirmed)
• Clinical symptoms

The above provides sufficient information to order most imaging studies. Additional information may be necessary for complex cases. This may include:

• Results of past treatment history (previous tests, duration of previous therapy, relevant clinical medical history)

Based on clinical criteria, AIM will issue a RQI for Blue Choice PPO or forward the case to a nurse or physician for review. The physician reviewer may contact the ordering physician to discuss the case in greater detail within 2 business days of receipt of the request. Ordering physician or professional providers may also contact AIM's physician reviewer at any time during the RQI process. AIM will provide the ordering physician or professional provider with a RQI for Blue Choice PPO, which will be valid for 30 days from the date issued. The ordering physician or professional provider must write the RQI on the requisition for the imaging study. Issuance of an RQI is not a guarantee of payment. When submitted, the claim will be processed in accordance with the terms of a subscriber's/member's health benefit plan. Exams will be directed to the most cost effective outpatient providers in order to maximize subscriber's/member's insurance benefits.