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Diagnostic Imaging Program

Horizon is working with AIM Specialty Health® (AIM), a specialty benefits management company, to offer a Diagnostic Imaging Program to certain self-insured employer group health plans administered by Horizon. Our diagnostic imaging program is designed to help members make informed heath care decisions.

Diagnostic imaging is one of the most important clinical tools available. Horizon is committed to administering a comprehensive imaging management program designed to:

  • Improve the clinical appropriateness of imaging services through the application of evidence-based guidelines in an efficient and effective review process.
  • Get the most value from our network through a wide range of solutions, including assessment tools, cost and quality transparency and reporting.
  • Engage members and increase their understanding of the range of choices they have in selecting among imaging providers making informed decisions.

AIM performs prospective clinical case review Prior Authorization & Medical Necessity Determination (PA/MND) for outpatient, non-emergent imaging for Horizon members. The following procedures are included in the program:

  • Computed tomography (CT)
  • Computed tomography angiography (CTA)
  • Magnetic resonance imaging (MRI)
  • Magnetic resonance angiography (MRA)
  • Positron emission tomography (PET and PET-CT)
  • Nuclear cardiology:
    • Blood pool imaging
    • First pass ventriculography
    • Infarct imaging
    • MUGA
    • Myocardial perfusion imaging (MPI)

Providers should contact AIM to obtain an order number before scheduling or performing any elective outpatient imaging service.

Services performed in conjunction with Emergency Room services, inpatient hospitalization or urgent-care facilities are excluded. Both ordering physicians (those referring the member for imaging) and servicing providers (those free-standing or hospitals that perform imaging) may submit requests. We recommend that servicing providers confirm an order number has been issued before rendering services.

How to Request a Review

AIM Clinical Appropriateness Guidelines for Radiology

Horizon’s diagnostic imaging program follows the AIM Clinical Appropriateness Guidelines for Radiology.

The AIM clinical guidelines are developed and revised through a rigorous review process that uses a comprehensive assessment of existing guidelines, evidence based standards and literature, and extensive feedback from the AIM External Physician Specialty Advisory Panel, which includes board-certified physicians from both community and academic practice.

For More Information

AIM Specialty Health® is a registered trademark of American Imaging Management, Inc.

American Imaging Management, Inc. supports Horizon Blue Cross Blue Shield of New Jersey in the administration of specialty benefits management. American Imaging Management, Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.