Anthem BCBS, BlueAdvantage Administrators of Arkansas roll out new imaging management program for their members in Michigan

A new imaging management program for many Anthem Blue Cross Blue Shield and BlueAdvantage Administrators of Arkansas members who live in Michigan went into effect Jan. 1, 2013.

It requires designated Anthem BCBS and BlueAdvantage members to obtain authorization for elective, outpatient
high-tech radiology services. These include CT scans, MRIs and nuclear cardiology tests, as well as PET and echocardiography exams.

Health care providers can determine if a member participates with the program by checking the back of their identification card for a high-tech imaging precertification phone number. You can request authorization by calling the number. (Members may also initiate the request.)

Note: The only BlueAdvantage members included in the program are Tyson and Walmart employees.

The program, managed by AIM Specialty Health^SM, includes two main components:

• Authorization needed

  Designated members must obtain authorization through their health care providers for elective, outpatient high-tech radiology services* managed by AIM Specialty Health.

  Authorization is not needed for imaging performed in conjunction with emergency room services, inpatient hospitalization, outpatient surgery (hospitals and freestanding surgery centers), urgent care centers or 23-hour observations.

• Imaging facility options

  Members who are referred to an imaging provider may receive a call from AIM if there is a lower cost, high-quality provider available within 30 miles. Members can choose either to follow their doctor’s referral or go to the AIM-referred facility.

  This outreach effort will not include pediatric or cancer patients.

If authorization is not obtained, a member may be responsible for the full cost of the imaging service. Participating health care providers should continue to bill for covered services following established procedures.

If you have any questions or need more information, contact your provider consultant or call the imaging precertification number on the back of the member’s ID card.