Diagnostic imaging management program

Prior plan approval is now required for high-tech diagnostic imaging services listed below when performed in a physician's office, the outpatient department of a hospital, or a freestanding imaging center on or after February 15, 2007.¹

• CT/CTA scans
• MRI/MRA scans
• Nuclear cardiology studies
• PET scans

Ordering physicians for BCBSNC members must contact AIM to obtain prior plan approval (also known as prior review or prior authorization) before scheduling an imaging exam for the outpatient diagnostic, non-emergency services listed above.

Servicing providers (hospitals and freestanding imaging centers) should confirm that prior plan approval was issued prior to performing the service. Issuance of prior plan approval is not a guarantee of payment. When submitted, the claim will be processed in accordance with the terms of the patient's health benefit plan. Only ordering physicians can obtain prior plan approval. Hospitals and freestanding imaging centers that perform the imaging services listed cannot obtain prior plan approval.

The diagnostic imaging management process is based upon AIM's clinical practice guidelines. They are developed from consensus opinion in medical practice and integration of medical information from multiple sources. These sources include:

• American College of Radiology (ACR) Appropriateness Criteria
• American Institute of Ultrasound in Medicine (AIUM)
• Society of Nuclear Medicine (SNM)
• American Academy of Neurology (AAN)
• American College of Cardiology (ACC)
• American Heart Association (AHA)
• American Medical Association (AMA)
• Agency for Healthcare Research and Quality (AHRQ)

BCBSNC recently conducted informational seminars for physician staff, provider billing, referral, and scheduling personnel throughout North Carolina. Training sessions included detailed information about the program and checklists to help office staff understand and efficiently utilize the prior plan approval process for diagnostic imaging. You may download PDFs of the training materials by selecting the links below.

Diagnostic Imaging Provider Training (3.6MB) 

DIM Servicing Provider Quick Reference Guide (356KB) 

DIM Ordering Provider Quick Reference Guide (347KB) 

For more information about the Diagnostic Imaging Management program and how you can request prior plan approval for dates of service on or after February 15, 2007, please visit the Diagnostic Imaging Procedures page.