Preauthorization changes to Radiology Management Program become effective Jan. 1, 2015

We’re notifying you of two upcoming changes to our PPO Radiology Management Program, administered through AIM Specialty Health. Starting Jan. 1, 2015, we will:

1. Require preauthorization for the following cardiac imaging procedures:
• Stress echocardiography
• Transesophageal echocardiography
• Resting transthoracic echocardiography
• These services do not require preauthorization today, either in the office or in a hospital outpatient location
2. Enforce preauthorization for radiological procedures that are part of the Radiology Management Program and are performed in hospital outpatient locations.
• Today, claims for services performed in the office location are adjudicated based on the results of the preauthorization process. If preauthorization has not been obtained for the service, the service is rejected and the provider is responsible for the charges.
• After Jan. 1, 2015, hospital outpatient and professional services performed in the outpatient hospital setting — without required authorization — will be denied as a provider liability. Once this change becomes effective, we will no longer issue quarterly hospital-specific compliance letters and related reports.

Standard PPO Radiology Management Program guidelines apply to both these changes.

We’ll provide additional details in The Record later this year. In the meantime, contact your provider consultant if you would like more information.