Radiology Quality Initiative (RQI) promotes the use of advanced diagnostic imaging services based on widely accepted clinical judgment. We have partnered with AIM Specialty HealthSM (AIM) to administer the program for all our members.
Our commitment to our members includes ensuring they receive appropriate care and the best health care experience, while also being responsible stewards of the cost of health care.
There are two components to RQI, our radiology benefit program. They include:
- RQI order number requirements 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.
- 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 it is determined by AIM that 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.
The RQI program applies to all members residing in Idaho, Oregon, Utah and Washington as indicated below:
|Type of member||
Component #1 -
RQI order number
|Component #2 - Advanced Imaging Authorization|
|Medicare Advantage products||Yes||Yes|
|Federal Employee Program (FEP)||Yes*||No|
|Individual and group products||Yes||Yes|
|Administrative Services only (ASO) groups (PDF). Learn more about ASO groups.||Yes||No|
|Asante (Group #10017473)||Yes||No|
|Regence Group Administrators (RGA)||Yes||No|
|Cambia Health Solutions (Group #60018408)||Yes||No|
|KingCareSM Health Plan (Group #10017241)||Yes||No|
Alsco Inc. (Group #70000002), CHG Healthcare Services (group #70000004), Dominion Questar (Group #70000001), IEC Group (Group #70000000),
U.A. Local Union 290 (Group #70000003)
|Regence Bridge Medigap||No||No|
|Any member where we are in the secondary health plan coverage position||No||No|
|BlueCard (Blue Cross Blue Shield members from other Plans who are not Regence members)||No||No|
|Group, Individual and Medicare Advantage members receiving care outside our service area||Not required, however it is encouraged||No|
Note: At this time FEP is 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 advance radiology services through AIM. If you encounter any eligibility issues, please contact FEP Customer Service.
An ASO group 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 upon the group. It is therefore important to check on a monthly basis to determine if our ASO group list (PDF) has changed because of an ASO group purchasing this portion of the program.
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