Failure to obtain an RQI number alone will not impact claims payment.RQI requirements are for notification purposes only.The RQI program does not apply to Medicare primary members with BCBSTX Medicare supplement.Facilities can now obtain an RQI from AIM on behalf of the ordering physician.View the AIM RQI Procedure Codes for this program. When an RQI is needed, health care providers must contact AIM before ordering or scheduling the following outpatient diagnostic imaging services when performed in a physician's/professional provider's office, the outpatient department of a hospital or a freestanding imaging center: Payment may be denied if procedures are performed without authorization and health care providers may not bill the patient.ĪIM provides clinical appropriateness review and education for outpatient high-tech diagnostic imaging services through their prenotification Radiology Quality Initiative (RQI) program for some Blue Choice PPO SM members.For joint and spine surgery prior authorizations, if an outpatient or inpatient facility stay is being requested, providers will contact AIM first for medical necessity determination, then contact BCBSTX for final determination of length of stay & the level of care.
Ordering physicians or servicing providers (facilities) may submit prior authorization requests.Services can vary depending on the patient benefits. Providers need to determine if prior authorization is required through AIM before rendering services.Joint and Spine Surgery, and Pain Management.Select category below for details from the AIM website. With AIM administering prior authorizations, we can optimize our programs, further ensuring that care aligns with established evidence-based medicine. Employees Retirement System of Texas (ERS) participants (Effective ).Teacher Retirement System of Texas (TRS) participants.Blue Premier SM and Blue Premier Access SM.AIM Prior Authorization ProgramĪIM provides required prior authorization review and approvals for select outpatient services. Prenotification Radiology Quality Initiative (RQI) program for outpatient high-tech diagnostic imaging servicesīe sure to verify eligibility and benefits and check prior authorization/prenotification requirements through Availity ® or your preferred vendor to determine if a prior authorization or an RQI is needed for the patient depending on their benefit plan.Prior authorization and post service medical necessity review for certain outpatient services.AIM is a specialty health benefits company that works with leading insurers to improve health care quality and manage costs for today’s most complex and prevalent tests and treatments, helping to promote care that is appropriate, safe and affordable.
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