AmeriHealth is contracted with AIM Specialty Health® (AIM) to perform precertification for outpatient non-emergent diagnostic imaging services and certain high-technology radiology services for our managed care members.
Effective January 1, 2018, AmeriHealth will require precertification/preapproval through AIM for fractional flow reserve when performed as part of coronary artery computed tomography angiography, for most members enrolled in its commercial HMO and PPO products.
AIM is updating its clinical guidelines effective January 1, 2018, to reflect information on Coronary CT Angiography (CCTA) and CT Derived Fractional Flow Reserve (FFR-CT). Visit AIM's website to access the Clinical Appropriateness Guidelines: Advanced Imaging that go into effect January 1, 2018.
Submitting requests to AIM
Ordering physicians ? primary care providers or specialists ? are required to obtain precertification through AIM's ProviderPortalSM, which providers can access directly through AIM's website or through the NaviNet® web portal by selecting Authorizations from the Workflows menu and then AIM.
Review procedures
AIM will utilize their Clinical Appropriateness Guidelines for Radiology when reviewing requests for commercial HMO and PPO members. AIM?s medical necessity guidelines are consistent with the clinical appropriateness criteria based on technology assessment, peer-reviewed medical literature including clinical outcomes research, and consensus opinion in medical practice. In addition, there are certain services in which the AmeriHealth policy is applied by AIM during the precertification/preapproval process.
Policy
For more information about the high-technology radiology services that require precertification/preapproval, refer to the current version of the AmeriHealth Medical Policy #09.00.46s: High-Technology Radiology Services.
To view this policy, visit to our Medical Policy Portal. Select Accept and Go to Medical Policy Online, select the Commercial tab, and then type the policy name or number in the Search field.
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