To help control rising health care costs, Blue Cross and Blue Shield of Illinois (BCBSIL) has contracted with American Imaging Management (AIM) to implement a statewide utilization management and quality improvement program of high-tech outpatient diagnostic imaging services. Beginning April 3, a Radiology Quality Initiative (RQI) program will be implemented for elective, outpatient, high-tech imaging services - MRI, PET, CT, Magnetic Resonance Angiography (MRA) Scans and Nuclear Cardiology - for all members, except HMO, residing in Illinois and Lake County, Indiana.

The RQI program promotes appropriate ordering of outpatient diagnostic imaging services based upon the member's diagnosis, while minimizing unnecessary radiation exposure.
What does this mean?Effective for dates of service on or after April 15, 2006, all non-emergency imaging services listed above, when performed in a physician's office, outpatient department of a hospital or a freestanding imaging facility will require an RQI number.
How RQI WorksPhysicians ordering an imaging exam for the elective high-tech services must contact AIM prior to scheduling. The recommended service is evaluated to determine the appropriateness according to diagnosis. AIM will also direct the ordering physician to a contracting network provider as needed.

AIM will provide a consultative service to physicians, helping them select the most appropriate radiological service for their patients. Although physicians' orders will go through AIM's clinical review process, no denials will be given and no medical necessity decision will be rendered. The RQI process will be transparent to members.

Contact AIMOrdering physicians can obtain and imaging service providers can confirm a patient's RQI number either online; www.americanimaging.net or by calling AIM's RQI Department toll-free at 1-866-455-8415 Monday through Friday, 8:30 a.m. to 6:00 p.m. (CST).

Note: issuance of an RQI number is not a guarantee of payment. The claim will be processed in accordance with the terms of the subscriber's health benefit plan.
Physician Training AIM and BCBSIL are currently providing extensive training for physicians on the RQI processes, along with a guidebook including program instructions and contact information. Additionally, training schedules for the RQI Program are currently available on our web site at www.bcbsil.com.

For more information about BCBSIL health plans please visit www.medequote.com