ODS and American Imaging Management (AIM®) Diagnostic Imaging Management Services
- Who is American Imaging Management?
- Why does ODS use the Diagnostic Imaging Management Services program?
- Why is ODS focusing on advanced diagnostic imaging?
- What are the goals of the Diagnostic Imaging Management Services program?
- What are the requirements for this program?
- What types of diagnostic imaging exams are covered under this program? What types are excluded?
- How does a physician office staff member obtain a preauthorization and order ID number from AIM?
- How does the Diagnostic Imaging Management Services program work?
- For how long is the order number valid?
- Does AIM need to know when the procedure is scheduled?
- Will members be able to contact AIM?
- What is the imaging providers’ role in the Diagnostic Imaging Management Services program?
- Can providers obtain order numbers on a retroactive basis?
- I am a hospital-based imaging provider. Does this program apply to me?
- I have radiology equipment in my office. Will I be able to perform diagnostic exams in office and will I be required to obtain an order number to perform CTs, MRs, Nuclear Cardiology exams and PETs on ODS members?
- What online services does AIM offer? How do providers contact AIM after hours?
- How long does it take to obtain a user password after registering on AIM’s website?
- Is the ordering physician required to obtain an order number for an urgent case in the evening or on weekends?
- Who develops the clinical criteria for the program?
- What methods and resources are used to develop the guidelines?
Program Overview
Who is American Imaging Management?
American Imaging Management, Inc. (AIM) is a leading imaging management company with national experience working with leading health plans to promote the most appropriate use of advanced diagnostic imaging services through the use of widely accepted clinical content, advanced analytical capabilities and a commitment to provide excellent service.
Why does ODS use the Diagnostic Imaging Management Services program?
ODS has developed the Diagnostic Imaging Management Services program to promote the most appropriate use of advanced imaging services provided to ODS members.
Why is ODS focusing on advanced diagnostic imaging?
Advanced imaging is among the fastest growing clinical service in the healthcare system today, increasing at an annual rate of 10 to 20 percent a year nationally. While the rapidly improving technology and clinical application of these services are the leading drivers of growth, it is widely accepted that some proportion of this growth is due to procedures that are unnecessary.
Given the potentially negative clinical implications of unnecessary testing, such as exposure to high doses of ionizing radiation, as well as the high costs of these tests, ODS is implementing the Diagnostic Imaging Management Services program to promote the appropriate use of advanced imaging services.
What are the goals of the Diagnostic Imaging Management Services program?
ODS’ Diagnostic Imaging Management Services program is built on AIM’s Clinical Guidelines, which are designed to promote appropriate use of advanced diagnostic imaging services based on widely accepted clinical opinion of the use of these services. ODS has set the following goals for this program:
- Promoting the selection of the most clinically appropriate diagnostic imaging services based on a patient’s clinical needs
- Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation through provider education and collaboration
- Curtailing the performance of inappropriate advanced diagnostic imaging studies
- Advocating bio-safety issues, including reduction of unnecessary radiation exposure
- Enhancing quality of healthcare for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources
PROGRAM DESIGN AND REQUIREMENTS
What are the requirements for this program?
Ordering/referring non-radiology physicians must contact AIM to obtain an order number before scheduling elective outpatient diagnostic imaging services. In addition, radiology providers/free standing imaging centers should confirm that an order number has been obtained prior to service delivery.
What types of diagnostic imaging exams are covered under this program? What types are excluded?
The Diagnostic Imaging Management Services program includes outpatient (including hospital outpatient centers, free-standing imaging facilities and physician offices), elective CT scans, MRI, MRA, PET scans and Nuclear Cardiology studies. Other imaging services and imaging services provided in conjunction with emergency room visits, inpatient hospitalization, outpatient surgeries (hospital or freestanding surgery centers), or 23-hour observation are excluded from the program and do not require an order number.
How does a physician office staff member obtain a preauthorization and order ID number from AIM?
For services scheduled within Oregon, providers will need to contact the AIM Call Center at 877-291-0513, or go to AIM’s website, www.americanimaging.net/goweb. After registration, a provider can follow the easy-to-use online process to request an order ID number through Provider Portal – AIM’s interactive online application.
For services scheduled in Washington or Idaho on or after Jan. 1, 2012, providers will need to contact the appropriate party during the dates listed below to request a preauthorization and order ID number.
From 12/1/11-1/8/12:
- By calling ODS toll-free at 800-258-2037
On or after 1/9/12:
- By registering at AIM’s website, www.americanimaging.net/goweb. After registration, a provider can follow the easy-to-use online process to request an order ID number through Provider Portal – AIM’s interactive online application
- By calling AIM at 877-291-0513
How does the Diagnostic Imaging Management Services program work?
Ordering physicians’ offices submit order requests through Provider Portal — AIM’s interactive Internet application — or through the AIM Call Center. Web users or callers will be guided through an interview where member and ordering physician information (name, ID number, etc), diagnosis, symptoms, exam type and treatment/clinical history will be requested.
If the information provided meets AIM’s clinical criteria the web user/caller will then be guided to select an imaging provider where the imaging study will be performed, and an order number will be issued.
If all criteria are not met or additional information or review is needed, the case is forwarded to a Registered Nurse (RN) who uses additional clinical experience and knowledge to evaluate the request against clinical guidelines. The nurse reviewer has the authority to issue order numbers in the event that he or she is able to ensure that the request is consistent with AIM’s clinical criteria.
If an order number still cannot be issued by the nurse reviewer, the case is forwarded to an AIM Physician Reviewer (MD), who contacts the ordering physician directly to discuss the case and diagnostic imaging guidelines prior to issuing the order number. AIM’s Diagnostic Imaging Clinical Guidelines serve as a foundation for this collegial discussion. These guidelines are available for download on AIM’s website, www.americanimaging.net.
The Physician Reviewer can approve the case based on a review of information collected or through their discussion with the ordering physician. In the event that the AIM Physician Reviewer cannot approve the case based on the information previously collected and is unable to reach the ordering physician to discuss the case, or is unable to approve the case based on the information supplied by the ordering physician during the peer-to-peer discussion, the Physician Reviewer will issue a denial for the request.
For how long is the order number valid?
Order ID numbers are valid for 30 days after the date of issuance.
Does AIM need to know when the procedure is scheduled?
No, although a preauthorization and order ID number should be issued prior to scheduling the study. Order ID numbers are valid for 30 days from the date of issuance.
Will members be able to contact AIM?
Members should contact ODS directly if they have any questions about the Diagnostic Imaging Management Services program or their benefits.
What is the imaging providers’ role in the Diagnostic Imaging Management Services program?
Imaging facilities are strongly encouraged to verify that an order ID number has been obtained prior to scheduling the study. Please note: if a contracted service provider performs an imaging service that has not been assigned an AIM order ID number, the claim will be denied in full and the service provider will be responsible for all imaging costs; if a non-contracted service provider performs an imaging service that has not been assigned an AIM order ID number, the claim will be denied in full and the member will be responsible for all imaging costs.
Can providers obtain order numbers on a retroactive basis?
No, providers must follow the process to obtain a preauthorization and order ID number prior to performing diagnostic imaging services under this program.
I am a hospital-based imaging provider. Does this program apply to me?
Non-radiology specialists are required to request an order number for outpatient elective advanced imaging services regardless of their affiliation with a facility or practice. Inpatient diagnostic imaging is not included in this program. Hospital-based radiologists who only provide professional services are not required to participate in the Diagnostic Imaging Management Services program.
I have radiology equipment in my office. Will I be able to perform diagnostic exams in office and will I be required to obtain an order number to perform CTs, MRs, Nuclear Cardiology exams, and PETs on ODS members?
A preauthorization and order ID number is required to perform any elective, outpatient advanced diagnostic service, even for ordering physicians with their own imaging equipment. Contact AIM and request a preauthorization and order ID number for imaging studies to be performed at your office or facility.
What online services does AIM offer? How do providers contact AIM after hours?
Provider Portal – AIM’s interactive internet application – is available 24 hours a day, seven days a week, and helps ordering physicians and staff quickly and efficiently submit and verify requests for ODS members at any time via the web.
How long does it take to obtain a user password after registering on AIM’s website?
If an email address is provided during the registration process, the password will be sent within 24 to 48 hours upon completion of the registration.
Is the ordering physician required to obtain an order number for an urgent case in the evening or on weekends?
Emergency room services do not require an order number. Outpatient elective diagnostic imaging services are typically non-urgent in nature. For those rare requests that are medically urgent, providers should contact AIM directly on the next business day at 877-291-0513.
STANDARDS FOR IMAGING GUIDELINES, PRIVILEGING AND CREDENTIALING
Who develops the clinical criteria for the program?
AIM’s Diagnostic Imaging Clinical Guidelines are updated at least once a year and are reviewed by:
- An independent Physician Review Board, including cardiologists, orthopedic surgeons, radiologists, neurologists, and neurosurgeons
- Client Medical Directors
- Local Imaging Advisory Council (representing local physician communities)
- Physician Review Panels
In addition, AIM’s guidelines are submitted as part of AIM’s accreditation process to the National Committee for Quality Assurance (NCQA) and URAC.
What methods and resources are used to develop the guidelines?
Development of AIM’s Diagnostic Imaging Clinical Guidelines involves integration of medical information from multiple sources to support the reproducible use of high quality and state-of-the-art diagnostic imaging services. The process for criteria development is based on technology assessment, peer-reviewed medical literature, including clinical outcomes research and consensus opinion in medical practice.
The primary resources used for AIM’s Diagnostic Imaging Clinical Guidelines development include:
- American College of Radiology (ACR)
- Appropriateness Criteria American College of Cardiology (ACC)
- Appropriateness Criteria American Heart Association (AHA)
- American Institute of Ultrasound in Medicine (AIUM)
- American Cancer Society American Academy of Neurology (AAN)
- American Academy of Pediatrics (AAP)
- Society of Interventional Radiology (SIR) Society of Nuclear Medicine (SNM)
- Agency for Healthcare Research and Quality (AHRQ)
- Centers for Medicare and Medicaid Services (CMS)
- National Guideline Clearinghouse
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