OptiNet is an online assessment tool developed by to collect modality-specific data from imaging providers. This tool is as an enhancement to our Radiology Quality Initiative (RQI) program, which Carelon administers for Blue Cross and Blue Shield of Texas (BCBSTX). The OptiNet assessment process will help facilitate the provision of effectiveness. The information on OptiNet is based on information given by high- and low-tech imaging service providers. Areas of assessment include staff qualifications and equipment accreditation. Providers can update their information whenever necessary.
High-tech Imaging Service Providers
- If you bill BCBSTX for the technical component of Computed Tomography (CT/CTA), Magnetic Resonance Imaging (MRI/MRA), Nuclear Cardiology or Positron Emission Tomography (PET), you should already have completed Carelon's online OptiNet assessment.
- Your assessment data will be analyzed to determine a modality score (represented by a letter grade) for each modality you register.
- High-tech service provider modality scores for facilities are now available to ordering providers via Carelon's online directory.
- The Blue Cross Blue Shield Association’s National Consumer Cost Transparency (NCCT) data set will be utilized for transparency purposes for imaging procedures for BCBSTX Radiology Quality Initiative (RQI) program for Blue Choice PPOSM subscribers. This cost data, along with the modality score (determined using the provider assessment), and the facility's distance from the ordering physician's or professional provider's office will be displayed to the ordering physician or professional provider to assist them in making important health care decisions for their patient. The NCCT data set is submitted twice per year by BCBSTX using up-to-date, annualized claims information. *
- When the ordering physician or professional provider submits a patient's high-tech radiology order through the , the initial suggestions will only include imaging sites that have an "A" score. Please note: The ordering physician or professional provider will still be able to search for additional servicing providers in the Blue Choice PPO network.
*This applies to facilities only.
Low-tech Imaging Service Providers
The OptiNet tool is available to collect capability information from Blue Choice PPO providers who perform the technical component of X-ray, ultrasound, echocardiography and mammography services.
- Your assessment data will be analyzed to determine a modality score (represented by a letter grade) for each modality you register. (Exception: Modality scores will not be generated for mammography.)
- Low-tech provider modality scores will not be made available for viewing by ordering physicians or professional providers.
- Results will be utilized by BCBSTX for reporting and quality enhancement initiatives.
For More Information
Ready to begin?
Use the link below to register (select "BCBS PPO Texas" from the drop-down menu) and complete the online assessment. You can save your data as you go — no need to complete the assessment in one sitting. Upon completion, you will receive an email confirmation. The OptiNet tool will remain available to you if you need to make changes at a later date. You should update your information as necessary.
OptiNet is a registered trademark of Carelon Medical Benefits Management, an independent third party vendor that is solely responsible for its products and services. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors.