AIM Specialty HealthSM (AIM)
Rendering Facility/Provider
Quick Tips for Diagnostic Imaging Management Programs
The Anthem Blue Cross and Blue Shield Diagnostic Imaging Utilization Management (UM) and Consultation
Management (CM) programs require prior authorization for many Anthem members for the imaging services outlined
below.*
The following recommendations are offered for consideration in developing processes that will be effective for your
facility. These recommendations are for informational purposes only, and are not policies of Anthem or AIM.
Procedures Requiring Prior Authorization:
 CT /CTA  MRI/MRA  Nuclear Cardiology  PET Scan
 Echocardiography (prior authorization effective 9/1/2010)
To help ensure that you receive any required order ID numbers from the ordering physician/provider, please consider
these recommendations:

If a physician/provider office calls to schedule any Anthem member for a procedure that may require prior
authorization, request the order ID number at that time.

If an Anthem member calls to schedule an appointment for a procedure that may require prior authorization, and
does not have an order ID number, the rendering facility/provider may elect to call the ordering physician/provider
to obtain the prior authorization.

The rendering facility/provider can view the member’s order ID number by logging onto AIM’s secure website,
https://providerportal.com and registering as a “Servicing Provider”.

Studies ordered after normal business hours or on weekends should be conducted by the rendering
facility/provider, as requested by the ordering physician/provider. However, the ordering physician/provider must
contact AIM within two (2) business days to initiate the review process.

If the rendering facility/provider feels an additional service is necessary, they should call AIM at 866-714-1107 to
initiate the process. AIM will then contact the ordering physician/provider to complete the normal review process
for the additional services.
Important Notes

It is the responsibility of the rendering facility/provider to ensure that prior authorization has been obtained,
whenever necessary. Procedures performed that have not been properly reviewed will not be reimbursed, and
the member cannot be balance billed.

The order ID number is good for 30 days from the date the request was completed.

Order ID numbers are site-specific: Imaging requests handled by AIM include identification of the rendering
facility/provider. If the site of the service changes, the ordering physician/provider should notify AIM of the change
in advance of the service.
Rev 7-12
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of
Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association. Radiology management administered by
Aim Specialty HealthSM, a separate company.

Services rendered as part of emergency room, 23-hour observation or hospital inpatient setting are not
subject to prior authorization. Studies ordered after normal business hours or on weekends should be conducted
as requested by the ordering physician/provider. However, the ordering physician/provider must contact AIM
within two business days to initiate the review process.

If an Anthem member accesses diagnostic imaging services through a non-participating provider, it is the
member’s responsibility to ensure that the ordering physician contacts AIM for prior authorization of the services
when required under the member’s health plan.

AIM’s Diagnostic Guidelines can be found on the AIM website www.aimspecialtyhealth.com.

For cardiac imaging studies (including MPI, blood pool imaging, echocardiography, as well as cardiac MRI, PET,
and CT/CTA), either the ordering or servicing provider is asked to respond to the following two post-delivery
questions: (1) Categorize the exam results (normal, abnormal [related to reason exam ordered], abnormal
[unrelated to reason exam ordered], or inconclusive) and (2) Did this study conclude the investigation for the
suspected diagnosis that prompted the test or was subsequent imaging required (concluded investigation or
subsequent imaging required).
*Coverage for the services included under this program is subject in all cases to the terms, limitations, and exclusions set forth in the
member’s most recent Certificate of Coverage.
Rev 7-12
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. Independent licensee of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of
Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association. Radiology management administered by
Aim Specialty HealthSM, a separate company.