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Physician/Professional Provider Guide
*Effective July 1, 2008, the RQI Program will no longer apply to BlueChoice Solutions subscribers
Blue Cross and Blue Shield of Texas (BCBSTX) is contracted with American Imaging Management, Inc. (AIM) to provide clinical appropriateness review and education for outpatient high-tech diagnostic imaging services. AIM provides a Radiology Quality Initiative (RQI) number for BlueChoice/BlueChoice Solutions* 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/BlueChoice Solutions* RQI number, just log onto AIM’s Provider Portal 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
Products Included:
BlueChoice (Includes BlueChoice/BlueChoice Solutions* PPO/POS/EPO, FEP & HealthSelect)
BlueChoice/BlueChoice Solutions* 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 BlueCard subscribers.
HMO Blue Texas currently includes the 11-county service area surrounding Dallas/Fort Worth.
Effective November 1, 2007**, six counties in the Austin & San Antonio areas have been added to the preauthorization 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:
- Bastrop
- Bexar
- Comal
- Hays
- Travis
- Williamson
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 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 |
RQI/Preauthorization Checklist
(Required Information for All Online, Telephone or Fax 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:
Based on clinical criteria, AIM will either issue a Preauthorization for HMO Blue Texas or an RQI number for BlueChoice/BlueChoice Solutions* 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/BlueChoice Solutions*, 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)
SPECT/Nuclear Cardiology
**Effective November 1, 2007
revised 3/2008
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