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Enhancements to Radiology and Sleep Study Programs November 01, 2022 Claims & Coding

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to promoting care that is appropriate, safe, and affordable for our members. With that in mind, we are pleased to announce, effective January 1, 2023, the below enhancements to our Radiology and Sleep Study programs will be implemented by AIM Specialty Health® (AIM).

Outlier Management/Enhanced Review Program 

Blue Cross NC will improve the existing utilization management programs with AIM Specialty Health by enhancing reviews in the Radiology (DIM) and Sleep Management programs.  

The Outlier Management/Enhanced Review Program will review imaging and sleep services using clinical appropriateness criteria to help ensure that care aligns with established evidence-based medicine. AIM 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. 

Nuclear Medicine 

Additional nuclear medicine codes will be added to the Diagnostic Imaging Program for members who are participating in the program. Visit our prior authorings page for a full list of codes that require prior plan approval.

Neurostimulators

Additional procedure codes will be added to the Sleep Study program for members who are participating in the program. Visit our prior authorings page for a full list of codes that require prior plan approval.

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.    

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

  • Online
    • Get fast, convenient online service via AIM ProviderPortal (registration required). ProviderPortal is available 24 hrs/day, 7 days/week. Go to www.providerportal.com to begin. 
  • By phone
    • Call AIM Specialty Health 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.
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Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.

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