1 Data based on AIM health plan client utilization data.

2 Radiation Protection Report 118, “Report from NCRP: CT-based Radiation Exposure in U.S. Population Soars,” Diagnostic Imaging Online, April 16, 2007.

3 “Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007,” Archives of Internal Medicine, 2009.

4 European Commission, Radiation Protection Report 118, “Report from NCRP: CT-based Radiation Exposure in U.S. Population Soars,” Diagnostic Imaging Online, April 16, 2007.

An Independent Licensee of the Blue Cross and Blue Shield Association.

The Radiology Quality Initiative (RQI) ProgramHelping to promote high-quality health care

An Independent Licensee of the Blue Cross and Blue Shield Association.

9319 (5-13-10)

What Services are Included in the RQI Program?

• Computed tomography (CT) scans (excluding CCTA)

• Magnetic resonance imaging (MRI)/Magnetic Resonance Angiography (MRA)

• Nuclear cardiology

• Positron emission tomography (PET) scans

Imaging services and imaging services provided in conjunction with emergency room visits, inpatient hospitalization, outpatient surgeries (hospital or freestanding surgery centers), or 23-hour observation are excluded from this program.

As always, Blue Cross and Blue Shield of Nebraska is proud to provide you with health care coverage. We strive to provide you with the best services possible while educating you about ways to stay healthy.

Medical imaging has been an essential key to health care since the late 1800s, when x-rays were first discovered. Since then, technology has come a long way, from providing a way to view bone fractures to studying cells, soft tissues and organs and even providing three-dimensional images from inside the human body.

Diagnostic imaging procedures, such as Mag-netic Resonance Imaging (MRI) and Computed Tomography (CT) scans, are a great example of this advanced technology. These procedures are, quite simply, amazing when used appropriately. Frequently referred to as advanced imaging, these procedures provide physicians with important information, saving thousands of lives on a daily basis.

Advanced imaging is one of the fastest growing clinical services in health care, increasing at an annual rate of 10% to 20% a year nationally1.

Unfortunately, individuals who receive multiple imaging procedures can receive high doses of radiation. Between 1980 and 2006, the effective radiation dose that the U.S. population received from diagnostic procedures increased by 650%2.

A 2009 study in the Archives of Internal Medicine estimated that approximately 29,000 future cancers could be related to CT scans performed in the US in 20073.

BCBSNE Introduces New Radiology Quality Initiative (RQI) Program As part of our ongoing commitment to promote quality care, patient safety and the most appropri-ate use of health care resources, Blue Cross and Blue Shield of Nebraska is introducing a Radiology Quality Initiative (RQI) program to better monitor advanced diagnostic imaging performed in outpatient, non-emergent settings. We are espe-cially focused on those occasions when a patient undergoes multiple imaging procedures, increasing the amount of radiation he or she is exposed to.

This program requires physicians to request a unique order number before scheduling certain imaging services. Those physicians’ requests will be reviewed against clinical guidelines that are based on the most widely accepted uses of these studies. These guidelines will make sure that the right test is being ordered at the right time, promoting the most appropriate use of advanced imaging services.

Frequently Asked QuestionsWhy is Blue Cross and Blue Shield of Nebraska implementing this program? To help reduce unnecessary radiology services that are both costly and potentially harmful to our members.

Will this program cause my claims to be denied? No. We will not deny claims for failure to obtain an ordering number. However, you should be aware that it is within the discretion of the servic-ing provider (the one who is performing the tests) to decline to perform the imaging procedure without an ordering number from the referring physician (the one who is ordering the tests). You should discuss this program and its requirements with your referring physician to make sure an ordering number is obtained. The order number process is quick (usually about five minutes), and as long as your physician is following national guidelines, an approval will be granted.

Are physicians comfortable with having to use this process?Before implementing this program, Blue Cross and Blue Shield of Nebraska sought advice and feedback from physicians across Nebraska. Those physicians agreed that this program is an important step for the health and safety of their patients. The RQI program is very much an effort of collaboration and cooperation between Blue Cross and Blue Shield and Nebraska physicians.

When my doctor gets the order number, does that mean the imaging procedure will be covered under my insurance? No, this program is not tied to your benefits in any way. Claims will be processed according to the terms of your coverage in effect at the time the services were rendered.

What if I need a scan as part of an emergency? Emergency room visits do not require an order number.

Between 1980 and 2006, the effective radiation dose that the U.S. population received from diagnostic procedures increased by 650%2. The radiation dose in a single chest

MRI is equal to that of 500 standard chest x-rays4.

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