Pending changes

Changing from notification to prior authorization

Effective November 1, 2008

Instead of requesting RQI notification numbers for high-tech radiology services through American Imaging Management (AIM), providers must now request prior authorization.

Simplification of the peer-to-peer process
AIM may refer a small percentage of requests to an AIM physician for a peer-to-peer discussion before finalizing an authorization decision. AIM has announced an improvement in this process: Any clinician in an ordering provider's office may contact AIM to provide the information requested when a case has reached the peer-to-peer review stage. It is no longer required that the physician be part of this initial information-sharing; the physician will only be involved if additional information is needed.

Incentive increased
Providers who make their authorization requests online are eligible for an $8-per-order incentive for each successful submission (supplying complete clinical information meeting medical necessity criteria, leading to an immediate Web-issued authorization). This is a $3 increase in incentive.

Authorization requests for urgent services
Providers now have 5 business days instead of 3 to call AIM after the service is performed. Contact AIM toll free at 800 552-0020. You must specify that the services performed were urgent when you call.

If you have further questions, contact your field service representative directly or through the Provider Helpline at 800 942-4765.