AIM Specialty Health 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) number for BlueChoice PPO/POS subscribers and Preauthorization for HMO Blue Texas 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 number 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 BlueChoice RQI number, just log onto 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 RQI number. 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 number has been issued through the Preauthorization/RQI feature
- Online CPT Groupers & Clinical Guidelines are available
BlueChoice (Includes BlueChoice PPO/POS/EPO, FEP & HealthSelect)
BlueChoice physicians/professional providers must contact AIM first to obtain a RQI number 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 number 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/POS 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/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/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||Call AIM's Call Center at 800-859-5299, Mon - Fri, 6 am to 6 pm CT and 9 am to 12 noon on Saturdays, Sundays and Holidays|
|Fax Request||Note: Fax option is available only for physicians who are submitting clinical information for existing requests. Fax to AIM at 800-610-0050|
(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)
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 an RQI number for BlueChoice 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 two (2) business days of receipt of the request. Ordering physician/professional providers may also contact AIM's physician reviewer at any time during the Preauthorization/RQI number process. AIM will provide the ordering physician with a Preauthorization for HMO Blue Texas or an RQI number for BlueChoice, which will be valid for 30 days from the date issued. The ordering physician/professional provider must write the Preauthorization or RQI number on the requisition for the imaging study. Issuance of a Preauthorization or RQI number 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 local Professional Provider Network office.
*CT/CTA (Computerized Tomography Scans & Computerized Tomographic Angiography)
MRI/MRA (Magnetic Resonance Imaging and Magnetic Resonance Angiography)
PET (Positron Emission Tomography)