Requests for authorization for DIMP services performed after-hours, on weekends, or during holidays
Blue Medicare HMOSM and Blue Medicare PPOSM
Effective September 1, 2010, Blue Cross and Blue Shield of North Carolina (BCBSNC) extended its current diagnostic imaging management program (DIMP) to include members covered under its Medicare Advantage products - Blue Medicare HMOSM and Blue Medicare PPOSM.
BCBSNC is aware there may be times ordering physicians deem a patient requires an outpatient, high-tech diagnostic imaging management service be performed after hours, on the weekends or on a holiday - hours in which American Imaging Management (AIM) call center is not available. Therefore, we would like to provide clarification of the process for ordering physicians when unable to obtain prior approval for service(s).
If the ordering physician feels an outpatient, high-tech diagnostic imaging service is urgent in nature and cannot be delayed until the next business day the physician should proceed with the service. The ordering physician will have 48 hours or two business days to contact AIM and request authorization for the service. It is important to note that requests received outside of 48 hours will not be reviewed or approved by AIM.
When the request is approved - When the request is approved the authorization will display as the date-of-service in the "date window" of AIM's online portal. Appropriate notification will be forwarded to the ordering physician.
If a request is denied - If a request is denied for medical necessity reasons, AIM will send a copy of the Notice of Denial of Medicare Coverage (NDMC) to the provider and the member, notifying them of the denial. Note: AIM will NOT send the notification of denial payment (NPD) because a claim will not have been received. The NPD letter will be sent by BCBSNC upon receipt of the claim.
If you have questions regarding the DIM program or its extension to the BCBSNC Medicare Advantage members, please contact your regional Network Management representative.