UPDATE: AIM and Simultaneous Ordering of Multiple Imaging Tests
Release Date: July 5, 2012
Due to issues on AIM’s side, the changes outlined in this communication, did not go live on July 2nd as planned. AIM is looking at a fall implementation, but no date has been set; stay tuned for more details once they become available.
Original Release Date: June 22, 2012
Blue Cross Blue Shield of North Carolina (BCBSNC) is committed to provider collaboration and helping to ensure that our members receive care that is consistent with recognized best practices. With that in mind, we would like to advise you about an upcoming change to our diagnostic imaging management program administered by AIM Specialty HealthSM (AIM).
In order to promote more informed clinical decision-making and reduce unnecessary radiation exposure, starting on July 2, 2012, AIM requests involving simultaneous ordering of multiple examinations will be subject to more scrutiny than would be the case if these same tests were ordered sequentially.
Depending on the clinical situation, one or more of the requested studies might not meet medical necessity criteria until the results of the lead study are known. This is particularly true for exams involving contiguous body parts where clinical signs and symptoms may be coming from abnormalities involving either region or where different modalities can be considered to evaluate the same anatomy for the same clinical problem.
Requests involving multiple examinations of contiguous body parts that are not approved prior to physician review will be subject to a mandatory peer-to-peer conversation. If the AIM physician reviewer cannot reach the ordering provider, none of the multiple exams requested will be approved. Coverage of services will continue to be subject to all of the terms and conditions of the member’s health benefit plan and applicable law.
A copy of AIM’s guideline “Simultaneous Ordering of Multiple Imaging Tests” is attached for your reference.
If you have questions about these changes, please contact the Provider Blue LineSM at 1.800.214.4844.