Blue Cross’ PPO Radiology Management Program expands to include echocardiography services

On Jan. 1, 2015, Blue Cross Blue Shield of Michigan will expand its radiology management program for its commercial PPO product. The program will include preauthorization for nonemergency outpatient echocardiography performed in a physician’s office, freestanding radiology center or hospital outpatient setting.

Ordering providers must contact AIM Specialty Health^SM to request authorization prior to scheduling echocardiography procedures with the following CPT codes:

*93303, *93304, *93306, *93307, *93308, *93312, *93313, *93314, *93315, *93316, *93317, *93350, *93351.

The following are “add-on,” or secondary, codes for echo services that don’t require independent review:

*93320, *93321, *93325, *93352

Echocardiography services are already included in the radiology management program for BCBSM Medicare Advantage members. With this new change, preauthorization for the above CPT codes will now become a requirement for instate commercial PPO members as well.

The following are excluded from preauthorization:

• Services performed in the hospital inpatient, observation or emergency room setting
• Out-of-state PPO members
• State of Michigan members, prisoners or Federal Employee Program^® members.

Ordering providers may begin requesting prior authorization for stress echocardiography, resting transthoracic echocardiography or transesophageal echocardiography beginning Dec. 1, 2014. Requests may be submitted in one of these ways:

• Online through AIM’s ProviderPortal^SM at aimspecialtyhealth.com/goweb** .
• By phone Monday through Friday from 8 a.m. to 5 p.m. Eastern time at 1-800-728-8008.

The AIM portal is available 24 hours a day, seven days a week, and offers an easy-to-use interface for submitting requests and checking on the status of open requests. There’s a quick registration process to set up an account that will allow you to manage prior authorization requests for one or multiple physicians.

If you’re already registered on the AIM portal, you don’t need to register again. If you have questions about the registration process, call AIM Customer Service at 1-800-252-2021.

Pre-exam questions
Please note that during the prior authorization process, pre-exam questions will be asked for stress echocardiography, as well as coronary CT angiography, cardiac positron emission tomography and myocardial perfusion imaging. The purpose of the questions is to help identify the common risk factors for cardiac disease.

The questions facilitate order review and reduce the time it takes to receive your order number. Pre-exam questions will not be requested for pediatric patients under the age of 19.

As with other outpatient diagnostic services requiring preauthorization, we recommend that providers confirm that an order number has been issued by AIM before rendering services. This can be done by checking online or by phone, as described above.

Payments for billed services with dates of service on or after Jan. 1, 2015, will be denied if preauthorization is not obtained. Members may not be billed for these denied services.

Retrospective authorization requests are permitted, but only up to 60 days past the date of service.

If you have any questions about this change, please contact your provider consultant.

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