Blue Cross and Blue Shield of New Mexico (BCBSNM) has partnered with American Imaging Management (AIM)* to implement a Radiology Quality Initiative (RQI) program designed to meet the challenges of monitoring rapidly increasing utilization and managing rising high-tech imaging costs. The RQI program includes a prior authorization process promoting the utilization of relevant and cost-effective services by giving providers access to evidence-based guidelines that support ordering the most appropriate services for BCBSNM members.
Compliance with the RQI program is required. Ordering physicians (PCP or specialist) for BCBSNM members, with the exception of BlueCard or out-of-state members, must contact AIM to obtain an RQI number prior to scheduling an imaging exam for the outpatient, diagnostic, nonemergency imaging services listed below when these services are performed in a physician's office, the outpatient department of a hospital, or a freestanding imaging center:
• CT and CTA scans
• MRI and MRA scans
• PET scans
• Nuclear cardiology studies
Note: Outpatient diagnostic imaging procedures performed in an emergency room, urgent care facility, ambulatory surgery center, or during an inpatient or observation stay are not impacted by this process and do not require an RQI number.
Internet Requests:
Visit AIM's Web site**. AIM's online RQI function is fully interactive, processing RQI requests in real-time using proprietary clinical criteria. RQI numbers are provided immediately for approved requests over the Internet.
Ordering physicians and imaging physicians must register to begin using AIM's interactive Web site**. Once a physician is registered, she or he can request an RQI number and verify that an RQI number was issued or is correct. The content of AIM Web applications is secured through Verisign at 128-bit encryption.
Telephone Requests:
Call AIM's RQI Department toll-free at 1-866-745-1789, Monday through Friday, 8 a.m. to 5 p.m. (MT), to request an RQI number or to verify that an RQI number has been issued.
Fax Requests:
Complete an AIM provider fax form, including all required information, and fax to 1-800-610-0050. You may download the fax form from AIM's Web site**.
Required Information:
AIM requires the information below for every request. Please have the member's chart or office notes available.
- Insurance information
- Member's name, BCBSNM ID number, and date of birth
- Ordering physician's name and address
- Name of imaging facility where the exam will be performed
- Type of service requiring RQI number from AIM (CPT code optional)
- Reason (indication) for the imaging procedure and/or ICD-9 CM diagnosis code
- Results of pertinent previous studies (labs, x-rays, etc.) and treatments, including their duration
- Member's symptoms
Based on clinical criteria, AIM will either issue an RQI number or forward the case to a nurse or physician for review. The physician reviewer may contact the ordering physician to discuss the case in greater detail within two business days of receipt of the request. Ordering physicians may also contact AIM's physician reviewer at any time during the RQI process. AIM will provide the ordering physician with an RQI number, which will be valid for 30 days from the date issued. Issuance of an RQI number is not a guarantee of payment. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan.
Performing providers should confirm that an RQI number was issued. Issuance of an RQI number is not a guarantee of payment. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Hospitals and freestanding imaging centers that perform the imaging services listed cannot obtain an RQI number.
Some high-tech imaging services – primarily PET scans and cardiac imaging – may be determined to be as experimental or investigational and thereby denied, consistent with HCSC medical policy. In such situations, the requesting provider will be advised to follow standard appeal processes.
Note: RQI numbers are valid for 30 days from the date issued. Retrospective requests will not be considered.
If you have any questions regarding the RQI program, contact the Network Services Department at 505-837-8800, or 1-800-567-8540. You may also visit AIM's Web site** for further information.
*The relationship between Blue Cross and Blue Shield of New Mexico (BCBSNM) and American Imaging Management, Inc., is solely that of independent contractors.
**We do our best to ensure that the information on the Web site shown above is useful, but can't be responsible for the content of that site or any information you may take from there (please read our legal disclaimer). When you click on the site link above, it will open in a new window so that you can explore that site without having to leave here. When you are through visiting the other site, you can close that window and return to the BCBSNM site.
