The Preferred Radiology Program (PRP) was created to:
- Support referring physicians in their decision-making process
- Promote patient safety by eliminating unnecessary duplication of diagnostic services
- Maximize customer benefits by providing the most current clinical and technical recommendations to radiology providers
- Minimize patient out-of-pocket costs by directing patients to a diagnostic facility participating in the Blue Cross network
The following components are included in the program:
Precertification Available Online:
- Check eligibility and benefits electronically through your practice management system or ProviderAccess.
- PRP information is displayed on the Additional Coverage tab if precertification is required.
Preferred Authorization Program
The purpose of the PAP is to offer administrative relief for high-level performers. Benefits of the program include:
- For online requests, immediate authorization is provided once clinical information is submitted. Additional clinical notes or physician reviews are not required for an immediate authorization.
- For requests initiated by telephone, an immediate authorization is provided once the requestor responds to a series of clinical questions.
Preferred Authorization Program Eligibility Criteria
The program has been re-evaluated and the new eligibility criteria is as follows:
- The provider must have 50 precertification requests over a 12-month period.
- To be eligible for the Preferred Authorization Program, the Resolution Approved rate must meet a minimum threshold of 80%.
- To remain eligible for the Preferred Authorization Program, the Clinical Result Type Approved rate must meet a minimum threshold of 80%.
Note: Preferred Authorization Program eligibility is by individual National Provider Identifier (NPI).
In August 2021, all providers will be re-evaluated based on the new eligibility criteria and notified of updated PAP status effective October 2021.
Subsequent re-evaluation of each provider’s performance will be conducted annually to determine eligibility for continued participation in the program.
The Radiology Profile helps providers who request radiology precertifications track their performance and view other helpful information including:
- Number of precertifications ordered, approved, reviewed, denied, redirected or withdrawn by tax ID or NPI
- Detailed member information
- Clinical rationale for denied cases
- Clinical result types
To access the Radiology Profile on ProviderAccess, click on Profiles & Reports in the main menu, and then click "Radiology Profile by Physician" or "Radiology Profile by Tax ID" under Efficiency and Quality.
The Radiology Profile is updated monthly.
The Clinical Result Type Approved rate and the Resolution Approved rate displayed in the profile are used to determine PAP status. Precertification data from AIM Specialty Health is used in the profile and for PAP eligibility.
For additional information about the profile, view the Radiology Profile Overview.
Radiology Profile - February 2021
AIM Specialty Health (AIM), an independent company, provides evidence-based cancer treatment information to physicians on behalf of Blue Cross and Blue Shield of Alabama.