ODS introduces Diagnostic Imaging Management Services

As part of our ongoing commitment to promote quality care, patient safety and the most appropriate use of healthcare resources, ODS is introducing a new clinical review program for advanced diagnostic imaging performed in outpatient, non-emergent settings. This program is being introduced to ODS members enrolled in PPO, POS, HMO, Medicaid (OHP) and indemnity plans beginning October 19, 2009, and Medicare Advantage plans effective January 1, 2010. This program covers the following diagnostic imaging studies:

We chose to implement this program for several reasons:

To promote the appropriate use of advanced diagnostic imaging, effective October 19, 2009, ODS will require ordering physicians to contact American Imaging Management® (AIM®), our diagnostic imaging management vendor, to review orders for the diagnostic imaging studies covered under the program. These requests will be reviewed against clinical guidelines that are based on the most widely accepted uses of these imaging services. The review process will be done quickly and efficiently to ensure that it supports the physician-patient relationship.

Effective for dates of service on or after October 19, 2009, compliance with the imaging management program will be required for the diagnostic imaging services covered under the program when performed in a physician's office, the outpatient department of a hospital or a freestanding imaging center.

Ordering physicians must contact AIM to obtain an order ID number when requesting any of the above studies. Imaging studies performed in conjunction with emergency room services, inpatient hospitalization or rehabilitation, outpatient surgery (hospitals and freestanding surgery centers) or 23-hour observation will be excluded from this requirement. Imaging providers are strongly encouraged to verify that an order ID number has been obtained before scheduling and performing diagnostic imaging exams.

Service authorization for advanced imaging services is required for members. If authorization is not obtained in advance of receiving such services, the charges will be denied.

In-network physicians and providers who perform the imaging services are responsible for obtaining authorization on the member's behalf. Members electing an out-of-network physician or provider are responsible for ensuring that their physician or provider contacts AIM for authorization. Non authorized services performed by non participating providers will be denied, and the full charge will be the member's responsibility.

As an active participant in promoting the health of our members, ODS is committed to developing programs that will expand the access to quality care and the availability of affordable health coverage within this state. This program will help us to accomplish both of these goals creating additional value for members and employers.

For questions regarding this program, please contact your ODS Marketing Account Executive or Sales Representative at 503-243-3948.

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