AIM Specialty Health® (AIM) Precertification/Preapproval for Certain High-Technology Diagnostic Radiology Services for Medicare Advantage Members



    The Company requires precertification/preapproval through AIM Specialty Health® (AIM) for certain high-technology radiology services for most members enrolled in its Medicare Advantage HMO and PPO products. To direct the application of these services for our members, AIM utilizes Medicare coverage guidance (eg, Local Coverage Determinations [LCD], National Coverage Determinations [NCD]). If no Medicare coverage guidance exists, AIM utilizes their Diagnostic Imaging Utilization Management Clinical Guidelines* or Company medical policy. For more information about the high-technology radiology services that require precertification/preapproval, refer to the current version of medical policy #MA09.002: High-Technology Radiology Services, .

    This service has been implemented as part of the Company's Radiology Quality Initiative (RQI) program and is intended to improve the overall clinical appropriateness of diagnostic services.

    *AIM’s medical necessity guidelines are consistent with the clinical appropriateness criteria developed by the American College of Radiology (ACR). AIM’s evidence-based guidelines are supported by current medical literature and utilize resources from major medical organizations such as the American Cancer Society (ACS). AIM is fully certified and/or accredited by the National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC). To access the complete list of AIM Specialty Health Diagnostic Imaging Utilization Management Clinical Guidelines, click here.

    Issued on - 03/02/2015

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