[
As you may know, Independence is contracted with AIM Specialty
Health® (AIM), an independent company, 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 ProviderPortalSM
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 Network Coordinator.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.
]