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As you may know, 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. Ordering physicians – primary care providers or specialists ? are required to obtain precertification through AIM's ProviderPortal^SM for the following outpatient non-emergent diagnostic services:

• CT/CTA scans
• echocardiography
• MRA
• MRI
• nuclear cardiology services
• PET scans
• PET/CT fusion

For more information and a complete list of our high-technology radiology services, please refer to the following policies:

• Commercial: #09.00.46q: High-Technology Radiology Services
• Medicare Advantage: #MA09.002c: High-Technology Radiology Services

To view these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the version of the policy you'd like to view. Then type the policy name or number in the Search field.

Review authorized procedure codes and descriptions

We strongly encourage our servicing providers to review the procedure codes and descriptions that have been authorized before performing the service. If the procedures billed are not those that have been authorized, or within the same procedure code grouping of the codes that have been authorized, the service will be denied appropriately for "no authorization on file."

Both ordering and performing providers can access AIM's ProviderPortal through the NaviNet^® web portal by selecting Authorizations from the Workflows menu and then AIM or through AIM's website.

AIM's ProviderPortal is available 7 days a week and offers providers the following:

• an easy-to-use interface for efficient precertification requests;
• printable precertification summary information sheets for completed requests;
• online tracking of previous precertification requests and status of open requests.

If there is a discrepancy between the procedure to be performed and the procedure that received prior authorization/approval, the performing provider should work with both the ordering physician and AIM to address the discrepancy and request any necessary changes to the authorization before rendering service.

If you have any questions about precertification for diagnostic imaging services, please contact your Provider Partnership Associate or Network Coordinator.

NaviNet is a registered trademark of NaviNet, Inc.

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