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.
Effective January 1, 2018, Independence 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 and Medicare Advantage 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
Please note the following regarding the process used by AIM when reviewing these precertification/preapproval requests:
- Commercial. 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 Independence?s policies are applied by AIM during the precertification/preapproval process.
- Medicare Advantage. AIM will follow the established Medicare coverage guidance (e.g., Local Coverage Determinations, National Coverage Determinations) when reviewing requests for our Medicare Advantage HMO and PPO members. If no Medicare coverage guidance exists, AIM utilizes their Clinical Appropriateness Guidelines for Radiology or the Independence policy.
Policies
For more information about the radiology services that require precertification/preapproval, refer to the current versions of the following Independence policies:
- Commercial: #09.00.46s: High-Technology Radiology Services
- Medicare Advantage: #MA09.002e: High-Technology Radiology Services
To view these policies, visit to our
Medical Policy Portal. Select
Accept and Go to Medical Policy Online, select the
Commercial or
Medicare Advantage tab, and then type the policy name or number in the Search field.
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