Blue Cross and Blue Shield of North Carolina to Implement Diagnostic Imaging Management Program for Medicare Advantage Members Effective Apr. 24, 2023

Effective Apr. 24, 2023, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement the Diagnostic Imaging Management (DIM) program for Medicare Advantage members.

The Diagnostic Imaging Management program is part of Blue Cross NC’s existing prior review program that requires prior approval of certain high-tech imaging procedures. This program seeks to manage costs while helping to ensure that members get the right test, at the right time. Blue Cross NC partners with AIM Specialty Health (AIM) (known as Carelon Medical Benefits Management effective Mar. 1, 2023) to administer the program. 

Beginning Apr. 17, 2023, providers should contact AIM Specialty Health (Carelon) to request prior review for diagnostic imaging services for dates of service Apr. 24, 2023, and after.  

The following types of imaging services require prior approval: 

• MRI - Magnetic Resonance Imaging 
• MRA - Magnetic Resonance Angiogram 
• MRS - Magnetic Resonance Spectroscopy 
• CT - Computerized Tomography 
• CTA - Computerized Tomography Angiogram 
• Nuclear Medicine  
• PET - Positron Emission Tomography 

The Diagnostic Imaging Prior Review Code List can be found on the Prior Plan Approval page. 

Enhanced Review Program 
Blue Cross NC will also partner with AIM Specialty Health (Carelon) to add the Enhanced Review program to the Medicare DIM program. This program will add review to imaging services using clinical appropriateness criteria to help ensure that care aligns with established evidence-based medicine. AIM (Carelon) clinical guidelines are applied to the review and in select circumstances, additional medical records may be requested. By limiting records review to requests that are less likely to be appropriate, the effort required for prior authorization will be reduced.  

Providers are strongly encouraged to verify that prior authorization has been obtained before scheduling and performing services. Submitting medical records is not necessary unless requested by AIM (Carelon).     

To place an order request, you can submit prior authorization requests to AIM (Carelon) using one of the following methods:    

Online    

• Get fast, convenient online service via the AIM (Carelon) ProviderPortal (registration required). ProviderPortal is available 24 hrs/day, 7 days/week. Visit the Carelon Provider Portal to begin.  

By Phone

• Call AIM Specialty Health (Carelon) toll-free at 866-455-8414
• Hours: Monday – Friday 8:00 – 5:00 PM (EDT) 

If you have other colleagues in your practice who will be submitting prior authorization requests, we encourage you to share this notice with them.