New Anthem Imaging Program Rolls Out for Fully Insured Groups in Ohio

08-30-2017

For several years, Anthem has been reviewing routine imaging services for clinical appropriateness and, in some cases, calling members to help guide them to facilities that offer more affordable care. This has been done in partnership with AIM Specialty Health, a leading specialty benefits management company, and has driven significant cost savings for your clients and their employees.

Starting September 1, Anthem has updated their imaging offering for fully Insured clients in Ohio by working directly with providers to review the setting of the requested service for medical necessity.  This also helps make sure that our members get the best and most appropriate care.

Here’s how the program works:

  • A member’s doctor requests an outpatient, non-emergency CT scan or MRI through the AIM ProviderPortalâ„  or by phone. This is reviewed to determine if the imaging request meets clinical criteria.
  • NEW! If the provider is asking that the test be performed at an outpatient hospital, the request will be reviewed to determine if it is medically necessary to perform the service in that setting.
  • NEW! If we find it is not necessary to perform the test at an outpatient hospital, we will offer the doctor information on alternate sites.

Anthem will approve any requests for cases involving continuity of care, such as multiple sclerosis or oncology.  

Contact BUA for any questions you may have about this program.