High-tech Radiology Management Program Change, Effective April 1, 2015

Posted March 27, 2015 

Effective April 1, 2015, Blue Cross and Blue Shield of Illinois (BCBSIL) no longer requires providers to obtain Radiology Quality Initiative (RQI) numbers through AIM Specialty Health® (AIM) prior to ordering outpatient, non-emergency high-tech diagnostic radiology services for some Blue Choice PPOSM members. While obtaining RQI numbers through AIM is no longer required prior to ordering high-tech radiology services for these members, providers should continue to follow BCBSIL Medical Policy criteria when applicable.  

Exceptions and Reminders

As always, checking eligibility and benefits is an important first step. The above change applies only to some Blue Choice PPO members at this time. Obtaining an RQI through AIM at will continue to be required by BCBSIL when outpatient high-tech diagnostic studies are indicated for most other BCBSIL members.* Facilities cannot obtain an RQI on behalf of ordering physicians.

*For City of Chicago members, including non-Medicare Retirees, determination of medical necessity through Telligen at 800-373-3727 will continue to be required for approval of CAT, MRI and PET scans.

AIM Specialty Health (AIM) is an operating subsidiary of Anthem. AIM and Telligen are independent third party vendors that are solely responsible for the products or services they offer. BCBSIL makes no endorsement, representations or warranties regarding any products or services offered by independent third party vendors. If you have any questions about the products or services they offer, you should contact the vendor(s) directly.

Please note that the fact that a guideline is available for any given treatment, or that a service has been pre-certified or an RQI number has been issued is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. Certain employer groups may require pre-certification for imaging services from other vendors. If you have any questions, please call the number on the back of the member's ID card.