Frequently Asked Questions
Transition of the Radiology Quality Management and Utilization
Management Programs to American Imaging Management
Blue Cross Blue Shield of Georgia will transition the administration of its Radiology Quality Management and
Utilization Management Programs from National Imaging Associates (“NIA”) to American Imaging
Management (“AIM”) effective January 1, 2008. This document provides information for physician offices
regarding the transition and how to work with AIM most effectively.
Q. What are the Radiology Quality Management and Utilization Management Programs?
In August 2005, Blue Cross Blue Shield of Georgia implemented the Radiology Quality Management
and Utilization Management Programs (radiology benefits management programs) to enhance the
appropriate use of advanced diagnostic imaging procedures delivered in an outpatient, non-emergent
setting. Currently, National Imaging Associates administers the programs on Blue Cross Blue Shield
of Georgia’s behalf, and American Imaging Management will assume this role on January 1, 2008.
Q: Why is Blue Cross Blue Shield of Georgia switching from NIA to AIM?
Like Blue Cross Blue Shield of Georgia, AIM is a member of the WellPoint family of companies.
This close integration combines the clinical and service expertise of AIM with the strong local market
presence of Blue Cross Blue Shield of Georgia, benefiting providers and members by enhancing
service levels and offering technology tools that will improve the provider experience with our
radiology benefits management programs.
AIM is a leader in radiology benefits management with programs covering over 20 million people in
23 states. AIM's programs are driven by a strong clinical foundation and deliver excellent service to
providers through industry leading technology tools that enhance the effectiveness and efficiency of
the clinical review process.
Q. Will there be any changes to either the diagnostic imaging procedures or settings covered
under the program?
No. The advanced diagnostic imaging procedures requiring pre-authorization under the program will
remain the same: CT Scans, MRIs, Nuclear Cardiology, PET Scans, CTAs and MRAs. Outpatient settings
(other than emergency room and 23-hour observation) will be covered under the program.
Q. Will Blue Cross Blue Shield of Georgia continue to pre-authorize imaging services performed
in an observation setting?
Yes. Pre-authorizations for imaging services while a member is in an observation setting may be
requested by calling the Utilization Management telephone number on the member’s ID card.
Q. Will there be any changes for the Blue Cross Blue Shield of Georgia members who are
enrolled in the program?
BlueValue Secure members (those enrolled in Blue Cross Blue Shield of Georgia’s
MedicareAdvantage HMO product) will be added to this program in 2008. Please refer to our Web
site for details regarding the actual date of this change.
Q. How do I request pre-authorization from AIM?
Effective December 17, 2007, providers should begin contacting AIM to request pre-authorizations for
procedures with dates of service on or after January 1, 2008. Providers will be able to request pre-
authorizations through the following processes:
• Via the Internet
Providers can request pre-authorizations via AIM’s ProviderPortalSM, AIM’s full-service provider
Web portal. ProviderPortal is fully interactive, processing pre-authorization requests in real time
using AIM’s clinical criteria. Requests that meet clinical criteria receive immediate approval and
authorization numbers. The ProviderPortal is available 24 hours a day, seven days a week and
can be accessed at www.americanimaging.net. You may register for ProviderPortal sm access
beginning December 10, 2007. Registration instructions can be found by logging on to
• Via Telephone
Providers can request pre-authorizations by contacting AIM’s call center toll free at 866-714-1103,
Monday through Friday, 8:00 am – 5:00 pm ET. Please note that this is a new telephone number
and new hours for call center access.
• Via Fax
Providers can request pre-authorizations via fax by completing an AIM Provider Fax Form. You
may download this fax form from AIM’s Web site, www.americanimaging.net. Fax requests can be
submitted to AIM toll free at 800-610-0050. Please note that this fax number does not replace
the 877-254-4971, 404-842-8390 or 888-246-0226 fax numbers for other pre-authorization
Q. What information will AIM require in order to evaluate a pre-authorization request?
Please refer to the checklist below to ensure you have all the necessary information prior to
requesting a pre-authorization from AIM:
Member’s identification number, name, date of birth, and health plan
Ordering provider information
Imaging provider information
Imaging exam(s) being requested (body part, right, left or bilateral)
Patient Diagnosis (suspected or confirmed)
Clinical symptoms/indications (intensity/duration)
For most situations, the above will suffice. For complex cases, more information may be necessary,
Results of past treatment history (previous tests, duration of previous therapy, relevant clinical
Q. How will pre-authorization requests be reviewed by AIM?
AIM will review pre-authorization requests based on the Diagnostic Imaging Utilization Management
Program Guidelines. These guidelines have been developed through a comprehensive review of
leading, nationally recognized guidelines and literature regarding the use of diagnostic imaging. A
copy of the program guidelines may be found on AIM’s Web site, www.americanimaging.net.
If AIM approves the request based on the information submitted by the ordering provider’s office, the
provider will receive an authorization number. Authorization numbers can be received immediately
either via the telephone or the Internet.
If AIM cannot approve the request, the case will be forwarded to a nurse or physician for additional
clinical review. Nurse reviewers will request additional information regarding the case and have the
authority to approve a case if they receive the information necessary to confirm that the case is
consistent with program guidelines.
If the nurse reviewer is still unable to approve the case, the case will be forwarded to a physician
reviewer. A physician reviewer may contact the ordering provider within two (2) business days of
receipt of the request to discuss the case in greater detail. An ordering provider may also contact AIM’s
physician reviewers at any time during the clinical review process. Based on the interaction with the
ordering provider, the physician reviewer will either approve the case or issue an adverse
Q. How can I determine whether a pre-authorization has been obtained for a member?
Rendering providers will be able to contact AIM to determine whether a pre-authorization has been
obtained for a member covered under the program. Rendering providers will be able to obtain information
on pre-authorizations through the following processes:
• Via the Internet
Rendering providers can obtain information on pre-authorizations obtained for their imaging site
via AIM’s ProviderPortal. The ProviderPortal is available 24 hours a day, seven days a week
and can be accessed at www.americanimaging.net. You may register for ProviderPortal sm
access beginning December 10, 2007. Registration instructions can be found by logging on to
• Via Telephone
Rendering providers can request pre-authorizations obtained for their imaging site by contacting
AIM’s call center. The call center can be reached toll-free at 866-714-1103, Monday through
Friday, 8:00 am – 5:00 pm ET. Please note that this is a new phone number and new hours for
call center access.
Q. Is pre-authorization necessary when Blue Cross Blue Shield of Georgia is not the member’s
Q. What does the AIM pre-authorization number look like?
AIM’s pre-authorization numbers are seven (7) numeric characters.
Q. How long is a pre-authorization number valid?
A pre-authorization number issued by AIM is valid for 30 days.
Q. Can AIM handle multiple pre-authorization requests per call?
Yes, pre-authorization requests for multiple members can be made on the same call. In addition, up
to three (3) procedures per member may be requested on a single call.
Q. What happens if a member is authorized for a specific procedure (for example: a CT of the
abdomen) and during the course of this procedure, the radiologist or rendering provider feels
that an additional procedure requiring pre-authorization (for example: a CT of the pelvis) is
The radiologist or rendering provider should proceed with the additional procedure. If this occurs,
he/she should inform the member’s ordering provider that an additional test was performed on the
same day. AIM must be contacted for pre-authorization for the additional procedure no later than 2
business days after the services were rendered. The pertinent clinical information supporting the
additional procedure must be available at the time AIM is contacted.
Q. If AIM denies pre-authorization of an imaging study, is there an option to appeal the decision?
Appeals of decisions that apply to BlueValue Secure members would go through the Medicare
Advantage appeals process. All other appeals would go through the standard Blue Cross Blue Shield
of Georgia provider appeals process. Information about both of these processes can be found by