Echocardiography to Be Added to Blue Medicare Diagnostic Imaging Program January 1, 2014
Blue Cross and Blue Shield of North Carolina (BCBSNC) added echocardiography services as part of its diagnostic imaging management program for commercial members in January 2012. By adding echocardiography to the program, we’ve helped to ensure that eligible members can receive services that are consistent with recognized best practices. In January 2014, BCBSNC will expand the diagnostic imaging management program for our Medicare Advantage plans (Blue Medicare HMOSM and Blue Medicare PPOSM) to include echocardiography services, helping to uphold the same program benefits for our Medicare Advantage members.
BCBSNC’s diagnostic imaging management program is administered by AIM Specialty Health (AIM®), and providers already ordering and providing diagnostic imaging services for BCBSNC’s members will be familiar with program requirements.
Members enrolled in BCBSNC’s Medicare Advantage plans currently require diagnostic imaging prior approval for the following cardiac modalities:
- Myocardial perfusion imaging
- Cardiac CT/CTA
- Cardiac MRI
- Cardiac PET and blood-pool imaging
Effective with dates of service on or after January 1, 2014, prior approval will also be required for Blue Medicare HMO and Blue Medicare PPO members, in advance of the following services being provided:
- Transthoracic Echocardiography (TTE)
- Transesophageal Echocardiography (TEE)
- Stress Echocardiography (SE)
Ordering physicians for Blue Medicare HMO and Blue Medicare PPO members must contact AIM to obtain a prior approval number prior to scheduling an imaging exam for these outpatient services.
Beginning December 16, 2013, ordering providers may begin requesting prior authorization for SE, TEE, or TTE for dates of service on or after January 1, 2014, in one of the following ways:
- Online through BCBSNC's provider website Blue eSM
- Through the AIM Specialty Health (AIM®) Call Center at 1-866-455-8414
Please note that pre-exam questions (PEQs) will be requested for stress echocardiography. Completing the PEQs for these exams will reduce the time it takes to receive your order number.
We believe the changes that we have made to the cardiac imaging program further our objectives of providing a clinically appropriate, consistent and efficient case review process. For more information about our diagnostic imaging programs, visit us on the Web at providers.bcbsnc.com/providers/imaging.faces.
Blue Cross and Blue Shield of North Carolina contracts with Aim Specialty Health, an independent entity, to administer the diagnostic imaging management program. Neither BCBSNC nor its agents are affiliated with Medicare.