Advanced Radiology Imaging Preauthorization/Prenotification Requirements Through eviCore for Blue Choice PPO With Health Advocacy Solutions Members

March 2, 2018

On Oct. 2, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) posted a notice regarding benefit preauthorization requirements for Blue Choice PPO members with health advocacy solutions in the Disclosures Notices section of our provider website. This notice includes a list of additional care categories including advanced radiology imaging which require benefit preauthorization or prenotification as of Jan. 1, 2018.

Benefit preauthorization or prenotification for advanced radiology imaging procedures for members who have a BCBSTX Blue Choice PPOSM health advocacy solutions health plan must now be obtained through eviCore Healthcare (eviCore) effective Jan. 1, 2018 instead of American Imaging Management® (AIM). Therefore, a Radiology Quality Initiative (RQI) number through AIM is no longer required for these members.

Recently, a system issue caused the Availity™ Eligibility and Benefit Inquiry response to display preauthorization requirements through both eviCore and AIM® for advanced radiology imaging procedures for members with Blue Choice PPO with health advocacy solutions. This system issue has been resolved and providers may use Availity to accurately determine preauthorization or prenotification requirements.

Check Eligibility and Benefits First

General preauthorization or prenotification requirements and eligibility and benefits may be determined online using Availity or by your preferred web vendor. Obtaining benefit preauthorization or prenotification is not a substitute for checking eligibility and benefits.

For More Information

Refer to the Claims and Eligibility and Preauthorizations/Notifications/Referral Requirements sections of our provider website for additional information, such as definitions and links to helpful resources. Also, continue to watch for announcements in the News and Updates, as well as our Blue Review provider newsletter.  If you have any questions, please contact your Network Management Representative.

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third-party vendor that administers the RQI program for BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, Availity and AIM. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.