Change to the HMO Blue® Texas Precertification Requirements Effective 11/01/2007
Effective November 1, 2007, six counties have been added to the precertification** requirement for high tech outpatient diagnostic radiology procedures (CT/CTA scans, MRI/MRA scans, SPECT/Nuclear Cardiology studies & PET scans*):
The six additional counties are:
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 American Imaging Management (AIM) first to obtain a precertification** 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*.
Imaging services performed in the inpatient, emergency room, outpatient surgery and 23-hour observation settings, however, are not included in the precertification** requirement.
Please note that facilities cannot obtain a precertification** from AIM on behalf of the ordering physician.
Options for Obtaining a Precertification**
|Internet||Log onto AIM's Provider Portal|
|Telephone||Call AIM's Call Center at 1-800-859-5299, Monday through Friday, 6am to 6pm CST and 9am to 12pm on Saturdays, Sundays and Holidays|
|Fax Request||Complete the AIM referring physician/professional provider fax form, including all relevant information and fax to AIM at 1-800-610-0050|
Note: Physicians/Professional Providers who are contracted/affiliated with a capitated IPA/Medical Group, and physicians/professional providers who are not part of a capitated IPA/Medical Group but who provide services to an HMO member whose PCP is a member of a capitated IPA/Medical Group, must contact the applicable IPA/Medical Group for instructions regarding referral and precertification** requirements.
*CT/CTA (Computerized Tomography Scans & Computerized Tomographic Angiography)
MRI/MRA (Magnetic Resonance Imaging and Magnetic Resonance Angiography)
PET (Positron Emission Tomography)
** American Imaging Management (AIM) uses the term preauthorization