Required radiology authorization information

For each request for prior authorization of high-tech diagnostic radiology services, American Imaging Management (AIM) will require:

Patient information: Name, DOB, contract number from the patient's Priority Health ID card
Ordering physician's name and address
Imaging provider name and address
Type of service and CPT code if available
Reason (indication) for the imaging procedure, and/or ICD-9 CM diagnosis code
Patient's clinical symptoms, including intensity and duration
Name and results of relevant previous studies (labs, x-rays, etc.)
Name, type, and duration of relevant previous therapies/treatment, if any

Last modified 02/10/10