Reminder: BCBSNC policy when ordering diagnostic imaging services
Blue Cross and Blue Shield of North Carolina's (BCBSNC) Diagnostic Imaging Management (DIM) Program was initiated in February 2007 to encourage the use of appropriate diagnostic imaging services at the appropriate time and in the appropriate order. Since implementation of the program, BCBSNC has communicated and made available various educational resources to assist in understanding the process for obtaining authorizations for diagnostic services.
To ensure adherence to the policy, BCBSNC would like to remind our network of healthcare providers that only ordering physicians should contact American Imaging Management (AIM) to request authorization for DIM services. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the certification, but should confirm a preauthorization number was issued prior to the rendering of services. There are two exceptions to this policy:
- If the ordering provider (PCP, specialist) has diagnostic imaging equipment in his/her office and will be filing the claim for the technical component (or billing globally) for the DIM service; or
- The servicing provider is an interventional radiologist, as established by BCBSNC's Credentialing Department.
BCBSNC's policy is based on the ordering, or referring provider, having sufficient clinical data on the patient to provide to AIM for medical necessity determination. It is unlikely the servicing provider, would have the patient's necessary clinical data - such as medical history, symptoms and/or diagnoses - as they are not liable for having seen the patient.
In an effort to provide further clarification, the rules of BCBSNC's DIM Program state that it is considered a violation of BCBSNC's policies for:
- A servicing location to market or offer to BCBSNC referring providers its services in obtaining the authorization from AIM on behalf of the referring provider; or
- A referring provider to allow the servicing location to contact AIM on their behalf to request the authorization for DIM services.
This policy is referenced in Section 8.9 of the BCBSNC Provider Blue Book and is therefore, incorporated by reference into BCBSNC's provider agreements. See https://www.bcbsnc.com/assets/providers/public/pdfs/BlueBook-July2010.pdf for details.
Questions regarding BCBSNC's policy for ordering diagnostic imaging services should be directed to your regional Network Management representative.