New members coming in 2020: Advanced Imaging Authorization updates

Additional Uniform Medical Plan (UMP) members will be transitioning from our Radiology Quality Initiative (RQI) program to our Advanced Imaging Authorization program beginning January 1, 2020.

This means more of your patients may be subject to the pre-authorization requirements of the Advanced Imaging Authorization program. If AIM Specialty Health (AIM) determines medical necessity is not met, the request will be denied.

View a full list of members who participate in this program. Read more about UMP.

Our radiology program promotes the use of advanced diagnostic imaging services based on widely accepted clinical judgment. 

Our commitment to our members means we're ensuring they receive appropriate care and the best health care experience, while we continue to be responsible stewards of the cost of health care. We have partnered with AIM Specialty Health (AIM) to administer our radiology program, which has two components:

  1. Radiology Quality Initiative (RQI) - Ordering/referring non-radiological physicians, other health care professionals and/or their trained staff must contact AIM to obtain an order number before scheduling an elective outpatient diagnostic imaging procedure.
    If an order number is not obtained through AIM prior to the imaging procedure being performed, the procedure will be considered a provider write-off and cannot be billed to the member.
  2. Advanced Imaging Authorization We provide full utilization management (UM) to review for medical necessity for our members. As part of our advanced imaging authorization review:
  • If AIM determines the service does not meet medical necessity criteria, the requested service/procedure will be denied and an order number will not be provided.
  • If an imaging provider performs the service/procedure without an approved order number, the procedure will be considered a provider write-off and cannot be billed to the member.

Members who participate in this program

The radiology program applies to all members residing in Idaho, Oregon, Utah and Washington.

View a list of members who participate in this program (PDF).

Administrative services only (ASO) groups may decide to purchase the Advanced Imaging Authorization component as a benefit during their annual renewal period. The renewal period can vary by month, depending on the group. It is therefore important to check on a monthly basis to determine if our list of members who participate in this program (PDF) has changed.

Note: BCBS FEP is currently not part of the claims compliance portion of this program; however, this may be subject to change in the future. Please continue to obtain your order number for advanced radiology services through AIM. If you encounter any eligibility issues, please contact FEP Customer Service.

Types of diagnostic imaging services included in this program

The following services are included in the program when they are performed in an outpatient, elective setting:

  • Nuclear cardiology
  • Positron emission tomography (PET)
  • Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA)
  • Computed tomography (CT)/computed tomographic angiography (CTA)
  • Stress echocardiography (SE)/resting transthoracic echocardiography (TTE)/transesophageal echocardiography (TEE)

The goals of this program are to:

  • Curtail the performance of inappropriate advanced diagnostic imaging studies
  • Advocate bio-safety issues, including reduction of unnecessary radiation exposure
  • Promote the selection of the most clinically appropriate diagnostic imaging services based on a patient's clinical needs
  • Encourage standardization of medical practice patterns and reduce variation in clinical evaluation through provider education and collaboration
  • Enhance quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources

Learn about program requirements and program design and criteria.

Obtain an order number

CPT codes

Program participation

Learn more

AIM worksheets