AIM Specialty Health (AIM) is a leading imaging management company with national experience working with health plans and providers to promote the most appropriate use of advanced diagnostic imaging services. This promotion is done using widely accepted clinical content and advanced analytical capabilities. 

Criteria review

What happens if the criteria for the imaging services are not met?

If all medical necessity criteria are not met or additional information or review is needed, the case will be forwarded to a registered nurse (RN) who will use additional clinical experience and knowledge to evaluate the request against clinical guidelines.

If the RN reviewer still does not believe the service meets the criteria, the case will be forwarded to an AIM physician reviewer, who will contact the ordering provider directly to discuss the case and diagnostic imaging guidelines prior to issuing the order number.

AIM's diagnostic imaging utilization management program guidelines serve as a foundation for this discussion.

The physician reviewer can approve the case based on evaluation of information collected or through his or her discussion with the ordering physician or other health care professional. If the AIM physician reviewer cannot approve the case based on the information previously collected, is unable to reach the ordering provider to discuss the case, or is unable to approve the case based on the information supplied by the ordering provider during the peer-to-peer discussion an order number will not be issued.

How can I check on the status of a request that was not approved at intake?

Users can check on the status of a request forwarded for additional clinical review by:

  • Checking AIM's ProviderPortal
  • Calling AIM Customer Service at 1 (877) 291-0509

If my request requires a peer-to-peer discussion with a physician reviewer can a member of my nursing staff handle this?

Yes. In the event that a request is transferred to an AIM physician reviewer for a peer-to-peer discussion, a member of the nursing staff may contact AIM to discuss the case on behalf of the ordering provider.

Can our patients contact AIM?

Health plan members should contact our Customer Service if they have any questions about our radiology program or their benefits. The phone number is listed on the back of the member ID cards.

Criteria development

Who develops the clinical criteria for the program?

AIM's guidelines for appropriate diagnostic imaging utilization have been reviewed and approved by the National Committee for Quality Assurance (NCQA) and the American Accreditation HealthCare Commission (URAC) and are reviewed annually by:

  • Client medical directors
  • Physician review panels
  • Local imaging advisory councils (representing local physician communities)
  • An independent physician review board, including cardiologists, orthopedic surgeons, radiologists, neurologists and neurosurgeons

View and download AIM Specialty Health's clinical guidelines.

What methods and resources are used in development of AIM's clinical practice guidelines?

Development of AIM's diagnostic imaging utilization management guidelines involves integration of medical information from multiple sources to support the use of high-quality and state-of-the-art diagnostic imaging services. The process for criteria development is based on technology assessment, peer-reviewed medical literature, clinical outcomes research and consensus opinion in medical practice.

The primary resources used for AIM's guideline development include:

  • American Cancer Society
  • National Guideline Clearinghouse
  • American Heart Association (AHA)
  • Society of Nuclear Medicine (SNM)
  • American Academy of Pediatrics (AAP)
  • American Academy of Neurology (AAN)
  • Society of Interventional Radiology (SIR)
  • Centers for Medicare & Medicaid Services (CMS)
  • American Institute of Ultrasound in Medicine (AIUM)
  • Agency for Healthcare Research and Quality (AHRQ)
  • American College of Radiology (ACR) appropriateness criteria
  • American College of Cardiology (ACC) appropriateness criteria