We’re making a change to our PPO radiology program for commercial and Medicare Advantage PPO products

Beginning Jan. 1, 2015, Blue Cross Blue Shield of Michigan PPO providers will have up to 60 days past the date of service to request retrospective authorizations through AIM Specialty Health for commercial and Medicare Advantage members participating in our Radiology Management Program.

This is a change from the current 30-day timeline. Although we have expanded this timeline, we still encourage providers to ensure an authorization is obtained prior to administering services.

We’d also like to clarify the roles of the ordering providers versus the rendering providers in requesting and making changes to authorizations. Although the ordering physician is responsible for obtaining a new authorization, there are instances when the rendering provider can request changes to that initial authorization directly from AIM.  These include:

• Change of location prior to the service being performe
• Modifying procedures performed on adjacent body parts from the original approved authorization.
  

Note:  A change in modality will require a new authorization to be requested by the ordering physician, even for the same body part.

Additionally, there are some situations that don’t require a change to the authorization because AIM approves procedures in the same grouping. For example, when the approved procedure is one with contrast but the rendering provider determines that it needs to be done without contrast, then no change is needed because both procedures fall within the same grouping.

To request an AIM authorization, call 1-800-728-8008 or visit AIMSpecialtyHealth.com**.

For more information about this change, please contact your provider consultant.

**Blue Cross Blue Shield of Michigan does not control this website or endorse its content.