This is a reminder of the new radiology transparency program being implemented
for AmeriHealth New Jersey members.
Starting June 1, 2012, AIM Specialty Health
SM (AIM) will present
ordering physicians with information about participating providers in New
Jersey who perform the technical component of advanced diagnostic imaging
services (CT/CTA, MRI/MRA, nuclear cardiology, and PET scans). When physicians
submit a precertification request for these services for their AmeriHealth New
Jersey patients, the following information will be made available:
each facility?s modality scores (i.e., scores for facility qualifications,
technologist and physician qualifications, accreditation, equipment, and
technical registration);
the facility?s average allowed payment amount (based on the professional and
technical components of previously billed services);
distance from the member?s home.
Member engagement
In addition, AIM will also engage AmeriHealth New Jersey members in the site
selection process to help them make important health care decisions regarding
advanced diagnostic imaging services. Once a precertification request has been
received for advanced diagnostic imaging services, AIM specialists will
proactively reach out to members with the same information. During this
outreach, members can potentially reduce their health care expenses by
selecting a different facility.
Please note that members will not be denied access to services if they do not
choose the site with the highest modality scores. Our goal is simply to provide
them with information to make informed choices about their health care.
For more information about this new transparency effort, please refer to the
April edition of
Partners in Health UpdateSM.
You can also contact your Network Coordinator.