AIM Specialty Health®' (AIM)' RQI/Preauthorization Program

Physician/Professional Provider Guide

Blue Cross and Blue Shield of Texas (BCBSTX) is contracted with AIM Specialty Health to provide clinical appropriateness review and education for outpatient high-tech diagnostic imaging services. AIM®' provides a Radiology Quality Initiative (RQI) for Blue Choice PPOSM members and Blue Advantage HMOSM members or Preauthorization for HMO Blue TexasSM members for outpatient high-tech diagnostic imaging services.

AIM's Provider Portal makes it easy for your office staff to enter an order for a high-tech diagnostic imaging exam via the web. The web-based Provider Portal gives you 24/7/365 access to the RQI (Radiology Quality Initiative), preauthorization, and claims and eligibility information. Best of all, not only can you enter an order for an exam, but you can receive a preauthorization or RQI online in real time (as long as additional clinical information is not needed).

Other processing enhancements include:

  • Diagnosis driven symptom listings
  • Multiple symptom selection
  • Expanded clinical indication for all specialties
  • Facilitates data collection

To obtain an HMO Blue Texas preauthorization or a Blue Choice PPO/Blue Advantage HMO RQI, just log in to AIM's Provider PortalSM  and complete the online questionnaire that identifies the reasons for requesting the exam. When criteria are met, you will be given a preauthorization or an RQI. If criteria are not met or additional information is needed, the case will be automatically transferred for further clinical evaluation, and an AIM nurse will follow up with your office.

Other online features include:

  • Convenient access. No waiting. Available 24/7/365
  • Location of radiology providers, in your patient's area, that are contracted with BCBSTX
  • Reduction of phone time by allowing information to be retrieved via the web
  • Confirmation that a preauthorization or RQI has been issued through the Preauthorization/RQI feature
  • Online CPT Groupers & Clinical Guidelines are available

Included Products

Blue Choice (Includes Blue Choice PPO, EPO & FEP)

Blue Advantage HMO

Blue Choice PPO/Blue Advantage HMO physicians or professional providers must contact AIM first to obtain a RQI when ordering or scheduling the following outpatient diagnostic imaging services when performed in a physician's/professional provider's office, or the outpatient department of a hospital, or a freestanding imaging center: CT/CTA, MRI/MRA, SPECT/Nuclear Cardiology studies or PET scans*. Please note that facilities cannot obtain a RQI from AIM on behalf of the ordering physician. Also, the RQI program does not apply to Medicare primary members with BCBSTX Medicare supplement. Medicare Primary members with BCBSTX commercial PPO coverage are included in the program.

Note: For BlueCard subscribers, please contact Customer Service utilizing the phone number on the back of the subscriber's ID card to determine if the RQI program applies.

HMO Blue Texas physicians or professional providers located in Bastrop, Bexar, Collin, Comal, Dallas, Denton, Ellis, Grayson, Hays, Johnson, Kaufman, Parker, Rockwall, Tarrant, Travis, Williamson or Wise counties must contact AIM first to obtain a preauthorization when ordering or scheduling the following outpatient diagnostic imaging services when performed in a physician's/professional provider's office, or the outpatient department of a hospital, or a freestanding imaging center: CT/CTA, MRI/MRA, SPECT/Nuclear Cardiology studies or PET scans*.

Note: HMO Blue Texas physicians or professional providers located outside of the following counties: Bastrop, Bexar, Collin, Comal, Dallas, Denton, Ellis, Grayson, Hays, Johnson, Kaufman, Parker, Rockwall, Tarrant, Travis, Williamson or Wise are not required to get preauthorization for outpatient, non-emergency diagnostic imaging services when ordering or scheduling the following outpatient diagnostic imaging services when performed in a physician's/professional provider's office, or the outpatient department of a hospital, or a freestanding imaging center: CT/CTA, MRI/MRA, SPECT/Nuclear Cardiology studies or PET scans*.

Other Options for Obtaining an RQI Number/Preauthorization

Telephone

AIM Call Center
800-859-5299
Monday – Friday, 6 a.m. to 6 p.m. CT
Saturdays, Sundays and Holidays, 9 a.m. to 12 p.m.

Fax Request

Fax to AIM at 800-610-0050
Note: Fax option is available only for physicians who are submitting clinical information for existing requests.



RQI/Preauthorization Checklist

(Required Information for All Requests)

Please utilize the checklist below as a guideline to ensure you have all the necessary information prior to requesting an RQI/Preauthorization from AIM:

  • Subscriber's/Member's identification number, name, and date of birth
  • Ordering physician's/professional provider's name, address, and telephone
  • Imaging provider information (name, location )
  • Imaging exams being requested (body part, right, left, or bilateral)
  • Patient diagnosis (suspected or confirmed)
  • Clinical symptoms

The above provides sufficient information to order most imaging studies. Additional information may be necessary for complex cases. This may include:

  • Results of past treatment history (previous tests, duration of previous therapy, relevant clinical medical history)

Based on clinical criteria, AIM will either issue a Preauthorization for HMO Blue Texas or a RQI for Blue Choice PPO/Blue Advantage HMO or forward the case to a nurse or physician for review. The physician reviewer may contact the ordering physician to discuss the case in greater detail within 2 business days of receipt of the request. Ordering physician or professional providers may also contact AIM's physician reviewer at any time during the Preauthorization/RQI process. AIM will provide the ordering physician or professional provider with a Preauthorization for HMO Blue Texas or a RQI for Blue Choice PPO/Blue Advantage HMO, which will be valid for 30 days from the date issued. The ordering physician or professional provider must write the Preauthorization or RQI on the requisition for the imaging study. Issuance of a Preauthorization or RQI is not a guarantee of payment. When submitted, the claim will be processed in accordance with the terms of a subscriber's/member's health benefit plan. Exams will be directed to the most cost effective outpatient providers in order to maximize subscriber's/member's insurance benefits.

View the CPT Codes  affected by this program.

For questions regarding this program, contact your Provider Relations office.


* CT/CTA (Computerized Tomography Scans & Computerized Tomographic Angiography)

MRI/MRA (Magnetic Resonance Imaging and Magnetic Resonance Angiography)

PET (Positron Emission Tomography)

SPECT/Nuclear Cardiology