Expansion of Diagnostic Imaging Management Program to Echocardiography
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 American Imaging Management (AIM®).
In addition to the cardiac modalities covered in the current diagnostic imaging prior approval program (Myocardial Perfusion Imaging, Cardiac CT/CTA, Cardiac MRI, Cardiac PET and Blood Pool Imaging), effective for dates of service on or after January 15, 2012, prior approval will also be required for the following services:
- Transthoracic Echocardiography (TTE)
- Transesophageal Echocardiography (TEE)
- Stress Echocardiography (SE)
Ordering physicians for BCBSNC members must contact AIM to obtain a prior approval number prior to scheduling an imaging exam for these outpatient services.
This expansion of the program is not applicable at this time for members enrolled in Blue Medicare HMO or Blue Medicare PPO.
Beginning January 8, 2012, ordering providers may begin requesting prior authorization for SE, TEE, or TTE for dates of service on or after January 15, 2012, in one of the following ways:
- Online through BCBSNC's provider website Blue e
- Through the American Imaging Management (AIM) Call Center at 866-455-8414.
Pre-Exam Questions (PEQs)
Please note that pre-exam questions will be requested for stress echocardiography. Completing the PEQs for these exams will reduce the time it takes to receive your order number. PEQs will not be requested for pediatric patients under the age of 19.
Collection of Post-exam Results
We are also requesting post-exam results for all cardiac exams (including cardiac CT/CTA, cardiac MRI, cardiac PET, MPI, blood pool imaging/MUGA, and echocardiography). Currently, post-exam results for cardiac imaging are not available through claims data. We are requesting this information from providers for several reasons:
- To generate data reports that will aid in the clinical review of future cases
- To aid in the development of our quality management initiatives
- To collect data for future program enhancements
- To help providers better understand how they are performing compared to their peers
- To focus more attention on selecting the right test the first time for BCBSNC members
The collection of post-exam results is voluntary. If you do not wish to submit post-exam results for cardiac services that are performed it will not impact your requests for exams or claims payment.
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.
If you have questions about these changes, please contact the Provider Blue LineSM at 1-800-214-4844.