High-tech radiology auth approval process

Imaging facilities need an authorization prior to performing any high-tech radiology service on a patient in order to be reimbursed.

The approval process for high-tech radiology authorization requests

1. The physician sends AIM an authorization request documenting the medical necessity of the requested radiology service.
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2. An AIM referral specialist receives the request and all pertinent clinical information related to the request.
3. Medical necessity review:
1. The referral specialist may approve the request immediately or refer it to an AIM Registered Nurse for review;
2. The nurse may approve it or refer it to a physician reviewer;
3. The physician reviewer may approve it or discuss it with a clinician at the requesting provider's office.
4. The request cannot be denied by anyone other than a physician reviewer, or without discussion with the requesting provider.
4. Approval or Denial: 

• AIM issues an authorization number to the physician and to the imaging facility scheduled to perform the service.
• Requests that do not meet medical necessity criteria will be denied.
• AIM will provide an advisement on alternative studies or procedures appropriate to the case.