Blue Review
A newsletter for contracting institutional and professional providers

May 2020

Attention High-Tech Imaging Providers: Complete Your OptiNet® Assessment

Our Radiology Quality Initiative (RQI) program, which promotes appropriate, safe and accessible diagnostic imaging for our members, is administered by AIM Specialty Health® (AIM). Obtaining an RQI number through AIM is required before ordering high-tech, outpatient, non-emergency imaging studies, such as Computed Tomography (CT/CTA), Magnetic Resonance Imaging (MRI/MRA), Nuclear Cardiology and Positron Emission Tomography (PET), scans for most Blue Cross and Blue Shield of Illinois (BCBSIL) PPO members.*

OptiNet is a key part of the RQI program. OptiNet helps to optimize the RQI program’s efficiency by collecting specific data from imaging providers. Data collected is used to evaluate the capabilities of imaging providers and help promote patient safety, cost effectiveness and accessibility of care.

If you’ve completed your OptiNet assessment, thank you! The data you entered in OptiNet was analyzed to calculate a score for each registered modality. Ordering providers can view your information in AIM’s online directory as part of the RQI process when they are selecting service locations for BCBSIL members.

Some high-tech imaging providers haven’t completed their assessments. If you bill BCBSIL for the technical component of CT/CTA, MRI/MRA, Nuclear Cardiology or PET scans, and you haven’t completed the OptiNet assessment, your facility won’t:

  • Appear in AIM’s online directory that ordering providers use during the RQI process;
  • Be one of the options suggested to members as part of AIM’s national Specialty Care Shopper program; or
  • Be considered for upcoming initiatives.

Take action now. Visit the Provider Tools section of our website for more information, like a link to the OptiNet Assessment tool and answers to frequently asked questions (FAQs). If you have questions about the assessment process, call AIM OptiNet Customer Service at 800-252-2021. Your assigned Professional Provider Network Consultant (PNC) is also available to help you with this and other BCBSIL programs and initiatives. To find your PNC, refer to the list of Provider Network Consultant Assignments.

*Certain employer groups may require preauthorization/pre-notification for imaging services from other vendors. If you have any questions, call the number on the member’s ID card.

AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. OptiNet is a registered trademark of AIM. 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 offered by such vendors, you should contact the vendors directly.

Please note that the fact that a guideline is available for any given treatment, or that a service has been preauthorized/pre-notified 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.