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Diagnostic Imaging Management Program begins in 1st Quarter 2007

Blue Cross and Blue Shield of North Carolina is implementing a Diagnostic Imaging Management Program in 1st Quarter 2007. BCBSNC is partnering with American Imaging Management, Inc. (AIM) to implement this program for the management of outpatient, high-tech diagnostic imaging services.

Effective for dates of service on or after February 15, 2007, prior plan approval is required for the outpatient diagnostic imaging services listed below when performed in a physician's office, the outpatient department of a hospital, or a freestanding imaging center.

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

Ordering physicians for BCBSNC members must contact AIM by Web or phone to obtain an authorization prior to scheduling an imaging exam for the outpatient diagnostic, non-emergency services listed above.

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

An authorization can be obtained and/or confirmed by logging onto Blue e, https://blue-edi.bcbsnc.com, and utilizing AIM's web-based application ProviderPortalSM. ProviderPortalSM, allows ordering physicians to obtain an authorization online. Imaging service providers can also go online to ensure that a patient has been issued an authorization or to confirm that the number is correct.

Beginning February 1, 2007, you will be able to obtain and verify authorizations by logging on to ProviderPortalSM through Blue e, 7 days a week, 4 a.m. to 1 a.m., Eastern time, calling toll-free at 1-866-455-8414, Monday through Friday, 8 a.m. to 5 p.m., Eastern time, or faxing AIM at 1-800-610-0050.

If you are not currently registered to use Blue e, you will need to register online at https://www.bcbsnc.com/content/providers/edi/bluee.htm. BCBSNC provides Blue e to providers free-of-charge. Once your registration is completed, please allow two weeks for processing.

Please note that not all BCBSNC groups will be participating in the Diagnostic Imaging Management program on February 15, 2007. BCBSNC will have a web-based search available on the bcbsnc.com Provider page and on Blue e that will allow providers to quickly search by group to see if authorization is needed. BCBSNC will update this system as new groups enter the program.

If you need more information on our Diagnostic Imaging Management Program, please contact your BCBSNC provider representative.