1. Diagnostic Imaging Quality Initiative Program Training Effective April 2, 2007 Updated 7/26/2007

2. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Diagnostic Imaging Quality Initiative Blue Cross and Blue Shield of Louisiana and HMO of Louisiana, Inc. (HMOLA), have contracted with American Imaging Management, Inc. (AIM) to implement a new Diagnostic Imaging Quality Initiative (DIQI) Program

3. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved DIQI Program Purpose The DQI program helps to promote:  Appropriate, safe ordering of diagnostic imaging studies for a given diagnosis  Performed in the proper sequence  Minimizing patient exposure to radiation  Maximum benefit to subscribers by the efficient use of their benefit plan

4. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Projected Growth in Imaging Procedures (2000-2008) Source: Sg2 281 299 323 349 374 401 430 450 471 Volume of Imaging Procedures (M) 600 2000 500 400 300 200 100 0 20012002200320042005200620072008 Projected Growth 2002-2008 MRICT ScanUltrasoundX-RAY 133%122%57%(9%) High-Tech Imaging Growth Imaging service volume will continue to increase as use of high-tech procedures drive growth.

5. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved  BCBSLA will require that an approval is obtained for outpatient high-tech diagnostic services beginning April 2, 2007  Program does not include:  Low tech diagnostic imaging (e.g., x-rays, ultrasounds)  Emergency room services and inpatient services including 23 hour observation  BCBSLA has contracted with American Imaging Management (AIM) to implement the program for outpatient imaging Program Description

6. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved American Imaging Management  Over 17 years of diagnostic imaging management experience  Managing 20 million members nationally  Operations are located in Illinois  URAC and NCQA accredited through 2008  Account Executive assigned to each client AIM is the most experienced company in the radiology management industry, partnering with health plans to promote the most appropriate, highest quality and most effective use of diagnostic imaging.

7. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Program Participation by Product Members Included Preferred Care PPO Network Advantage Blue Point of Service (POS) Health Maintenance Organization (HMO) Federal Employee Program (FEP) – beginning August 15, 2007 Members Not Currently Included Benefits Management Services (BMS) members Some ASO Groups Medicare Primary Members

8. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Services & Locations Computerized Tomography Scans (CT) Computerized Tomographic Angiography (CTA) Magnetic Resonance Imaging (MRI) Magnetic Resonance Angiography (MRA) Nuclear Cardiology Procedures Positron Emission Tomography (PET) Scans Imaging Services DIQI Required –Freestanding imaging centers –Hospital outpatient –In-office use of physician-owned equipment DIQI is Not Required –Inpatient –Emergency Room –23-hour Observation Locations

9. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Who needs to obtain a notification? ORDERING physicians must contact AIM:  notification numbers are valid for 30 days  Servicing providers cannot obtain a notification number for exams and should verify that a number has been obtained prior to performing the exam.

10. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Radiology Quality Initiative Process Ordering Physician Office AIM RN Review Notification Number Issued Notification Number Issued Notification Number Issued Exam Phone Order Entry: Call Center/ Imasis SM Web Order Entry: ProviderPortal SM OR Redirected Withdrawn Notification Number issued; Criteria Not Met Exam E & I Referred to Blue Cross for decision determination* *Exams may be referred to HealthPartners at RN or MD level Exam AIM MD Review Blue Cross Auth Line iLinkBLUE

11. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved How does the process work? A six-step, efficient process DEMOGRAPHIC INFORMATION  Member identification number, name, and date of birth  Ordering physician information CLINICAL INFORMATION  Imaging exams being requested (including body part, right, left, or bilateral)  Patient diagnosis (suspected or confirmed)  Clinical symptoms/ indications (including intensity/ duration) For most situations the above will suffice. For complex cases more information may be necessary. This might include:  Results of past treatment history (including previous tests, duration of previous therapy, relevant clinical medical history) Order Entry Information Required: Information necessary to complete the order at the initial interaction Information Required to Complete a Request

12. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Where to get a notification number ProviderPortal SM Available through iLinkBLUE at www.bcbsla.com/ilinkblue Blue Cross Authorization Line (800) 523-6435 AIM Call Center (866) 455-8416 Monday - Friday: 8:00 a.m. to 5:00 p.m. CST (Available beginning February 1, 2007) ProviderPortal SM Available through iLinkBLUE at www.bcbsla.com/ilinkblue Blue Cross Authorization Line (800) 523-6435 AIM Call Center (866) 455-8416 Monday - Friday: 8:00 a.m. to 5:00 p.m. CST (Available beginning February 1, 2007)

13. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved How to use the AIM Provider Portal SM in iLinkBLUE

14. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Easy to Use: Web Authorizations All web use is secure and HIPAA compliant 24/7/365 availability In addition to receiving notification numbers, provider offices can also verify approvals, confirm eligibility, and locate imaging providers Exam Summary that includes exam type, location, and member information Provider search capability CPT Groupers and Clinical Guidelines available online Servicing providers can confirm notification numbers obtained by ordering physician Web Features Providers can submit and receive pre-authorizations over the web on a real-time basis eliminating the need to call AIM Benefits of Using Web Tool The ProviderPortal SM is accessed through www.bcbsla.com/ilinkblue

15. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Accessing the AIM Provider Portal SM The ProviderPortal SM is accessed through www.bcbsla.com/ilinkblue www.bcbsla.com/ilinkblue Once in iLinkBLUE, the Provider Portal SM link is located under Authorizations on the menu bar.

16. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Accessing the AIM Provider Portal SM After clicking on the Imaging Authorization (AIM) link, you will encounter Blue Cross and AIM disclaimer pages. Once the disclaimers are viewed and accepted, you then are transported to AIM’s Provider Portal SM

17. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved You are about to leave the Blue Cross Blue Shield to go to AIM’s ProviderPortal sm. Please note Blue Cross Blue Shield of Louisiana has Medical Policy that supersedes the AIM Utilization Management guidelines for the following services : Coronary Artery Evaluation [71275] PET Cardiac [78459,78491,78492] PET Neuroimaging-Brain [78608-78609] PET Oncological-Cervical [78812,78813,78815,78816] PET Oncological-Ovarian [78812,78813,78815,78816] PET Oncological-Testicular [78812,78813,78815,78816] PET Oncological-Unknown Primary [78812,78813,78815,78816] If you would like to refer to the Medical Policy criteria on those policies listed above, click below to return to the iLinkBLUE menu and select the Medical Policy Coverage Guidelines Option. Return to iLinkBLUE Menu If you would like to proceed to AIM’s ProviderPortal sm click below acknowledging you have read the above information. Proceed to AIM Provider Portal You may also contact the Blue Cross Customer Service at (800) 392-4076 to request a copy of a Blue Cross Medical Policy. Appears when leaving iLinkBLUE to enter AIM’s Provider Portal SM Blue Cross Disclaimer You must click here to agree and continue to Provider Portal

18. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Update My Profile User Information Please update your user profile with the information below. Registrant First Name Registrant Last Name Work PhoneExt Fax E-mail Address Very E-mail Address = Required fields Notification Preferences Would you like to Receive Notifications from AIM? Yes No Please note that AIM does not share your personal information. Any email you receive from AIM will be You may be asked to update your profile information (this screen does not appear once information is updated). Completing this screen allows you to receive e-mail notifications when updates are made to your pended cases.  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Update Profile

19. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved AIM Disclaimer I Agree HIPAA Disclaimer  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Before proceeding, you must confirm that you are authorized to access Protected Health Information (PHI) as defined under the Health Insurance Portability and Accountability Act on behalf of the organization listed and the physicians linked to this organization. You must also agree to limit your access to the minimum amount of information necessary to perform a permitted treatment, payment or other health care operations activity. In the event you obtain access to information that you are not authorized to view, please notify AIM immediately at 1-800-252-2021. Failure to comply with these terms may result in immediate termination of your and your organization’s access to AIM’s Provider Portal. You must click here to agree and continue to Provider Portal My Homepage

20. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved ? Help Tips As you continue to use the system, this area will expand to display your most recent activity. Click on the ‘?’ to access the Help Tips column. April 2, 2007  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout My Homepage RQI Request Queue Member Name Member Number Date of Service RQI/Status Smith, John 123456789 10/03/2006 In Progress Smith, Jane 10/03/2006 1234567 My Homepage How do I start a preauth request or inquiry? Select RQI Request or RQi Inquiry from the RQI Manager menu option. How do I manage a long list of cases in my queue? You can sort the columns of the table by clicking the column titles. For multi- page tables, the paging controls located below the table allow you to move quickly through the table pages. How do I continue a preauth request case that I had left unfinished? Click the incomplete link in the RQI/Status column Welcome Provider

21. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved As you continue to use the system, this area will expand to display your most recent activity. April 2, 2007  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout My H Welc RQI Request Queue Member Name Member Number Date of Service RQI/Status Entered Date Action Smith, John 123456789 10/03/2006 In Progress 10 2006 Delete Smith, Jane 10/03/2006 1234567 10 2006 Delete AIMFor security purposes, you will need to re-enter your User Name and Password to Messages:access Provider Portal 2.0. Please bookmark this page for future use. Thank You! RQI Request RQI Inquiry Have a comment or suggestion? Start RQI Request Records Per Page 10

22. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved I Agree RQI Request Agreement  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Agreement Page 0 Please be as thorough as you can in completing the following questions. The determination of your Preauthorization Request depends on the information and details you supply. Answers should accurately reflect the patient’s medical history and be supported by the patient’s medical record. Additional questions may be asked if further clinical review is required. Please note that Preauthorization Requests may be subject to audit by AIM o by the health plan at any time. If you do not agree, you will not be able to use this application and you will be returned to the previous screen. RQI Request

23. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved As you continue to use the system, this area will expand to display your most recent activity.  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Member Search Results Member NameMember Number Date of Service RQI/Status Have a comment or suggestion? Enter Member ID Records Per Page 10 RQI Request Step: 1 2 3 4 5 Start New Request Select Health Plan BCBSLA Select Member Search By: Member Num 1234567890 Find Clear Step 1: Select Health Plan then Search for Member. Please complete all search fields thoroughly and accurately so that your search may be limited as much as possible.

24. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Member  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout RQI Request Member Name Member Number Relation Sex DOB Effective Date Term Date Smith, John 123456789 Employee M 01/22/1934 01/01/2006 12/31/9999 Smith, Jane 123456789 Spouse F 08/26/1938 01/01/2006 12/31/9999 Member Search Results Print This Page Delete This Request Total Number of Records Found: 2 T = Termed Member Have a comment or suggestion? ? Records Per Page 10 Example of Active Coverage Start New Request BCBSLA Select Member Search By: Member Numb 1234567890 Find Clear

25. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Member  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout RQI Request The selected member is currently not eligible for preauthorization. Please contact the health plan. RQI Summary Health Plan: BCBSLA Member Information SMITH, JOHN Member #: 123456789 123 MAIN ST, SUITE 300 ANYTOWN, LA 70000 Date of Birth: 01/22/1934 Member Name Member Number Relation Sex DOB Effective Date Term Date Smith, John 123456789 Employee M 1/22/1934 1/01/2006 12/31/9999 Member Search Results Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789 Return to Search Results Begin Another Request Print This Page ? Example of member who is not part of the RQI program

26. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Physician Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Physicians Records Per Page 10 Name DOE, JOHN PATEL, JOHN Total Number of Records Found: 2 Delete This Request RQI Request Step: 1 2 3 4 5 Have a comment or suggestion? A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Preferred Physician List Step 2: Select the Ordering Physician from the list or search by alphabetical index. If you do not see your physician, please verify your physician list using Manage My Groups.

27. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Date of Service and Exam Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789 Ordering Physician Edit PATEL, JOHN  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout RQI Request Step: 1 2 3 4 5 Have a comment or suggestion? Delete This Request Please select the Exam to be performed SELECT DATE OF SERVICE 10/3/2006 SELECT EXAM: MRA EXAM DESCRIPTION: MRA Abdomen MRA Chest MRA Head MRA Lower Extremity MRA Neck MRA Pelvis Step 3: Please select the Date of Service, Exam and Exam Description.

28. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Diagnosis Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789 Ordering Physician Edit PATEL, JOHN  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Clinical Review Details RQI Request Step: 1 2 3 4 5 If your patient has a known or suspected diagnosis please select the appropriate item from the list displayed below. Selecting a diagnosis will help meet clinical criteria without the need for additional clinical review. Please select a diagnosis from the list below ANEURYSM AORTIC DISSECTION AVM (ARTERIOVENOUS MALFORMATION) LOWER EXTREMITY CLAUDICATION MESNTERIC ISCHEMIA (INTESTINAL ANGINA) RENAL ARTERY STENOSIS (RAS) Exam: MRA Abdomen Clinical Review Details Step 4: Clinical Review – Please select Symptom/ Condition.

29. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Answer Clinical Question Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789 Ordering Physician Edit PATEL, JOHN  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Step 4: (continued) RQI Request Step: 1 2 3 4 5 Is this Diagnosis Confirmed or Suspected? Suspected Confirmed Confirmed Diagnosis: The patient has an established medical condition after study, including but not limited to: Laboratory Testing Prior diagnostic imaging exams Positive biopsy results Suspected Diagnosis: The patient has signs, symptoms and/or clinical findings suggestive of a medical condition that has not yet been confirmed. Exam: MRA Abdomen DX: ICD9: 440.1 Clinical Review Details Restart Process Continue

30. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Answer Clinical Question - Symptoms Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789 Ordering Physician Edit PATEL, JOHN  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Clinical Review Details Exam: MRA Abdomen DX: ICD9: 440.1 S/C: Confirmed RQI Request Step: 1 2 3 4 5 Select confirmation method from the list below and click Continue. RENAL ARTERY STENOSIS (RAS) Confirmed FOLLOW-UP AFTER SURGICAL OR INTERVENTIOANL PROCEDURE FOR RAS PERIODIC SURVEILLANCE IN PATIENT WITH DOCUMENTED RAS Restart Process Continue Step 4: (continued)

31. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Exam Information Member Details Edit Health Plan BCBSLA Member Smith, John Member#: 123456789 Ordering Physician Edit PATEL, JOHN  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Step 4: (continued) Exam Information Exam CPT Group Exam Type Action Exam 1 MRA Abdomen MRA Hide Details Delete Clinical Information Diagnosis: RENAL ARTERY STENOSIS (RAS) – Confirmed Symptoms: FOLLOW-UP AFTER SURGICAL OR INTERVENTIONAL PROCEDURE FOR RAS RQI Request Step: 1 2 3 4 5 Add Exam Next Print This Page Delete This Request Have a comment or suggestion?

32. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Provider  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout RQI Request Step: 1 2 3 4 5 Find a Facility Delete This Request Facility Selection Facility Name Address City State Phone Distance Map ABC IMAGE 100 ANY ST, STE 100 ANYTOWN LA (225) 999-9999 6.89 View ABC RADIOLOGY US 100 ANY ST, STE 100 ANYTOWN LA (225) 999-9991 8.22 View RADIOLOGY USA 100 ANY ST, STE 100 ANYTOWN LA (225) 999-9992 20.55 View US SCAN 100 ANY ST, STE 100 ANYTOWN LA (225) 999-9993 20.98 View A to Z IMAGING 100 ANY ST, STE 100 ANYTOWN LA (225) 999-9994 21.69 View Have a comment or suggestion? Records Per Page 10 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Preferred Physician List Step 5: Please Choose a Facility

33. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Provider  RQI Manager  File Manager  Reference Desk  Profile Manager  Step 5: Please Choose a Facility Find a Facility Dele Facility Selection Facility Name Address City State Phone ABC IMAGE 100 ANY ST, STE 100 ANYTOWN LA (225) 999-999 ABC RADIOLOGY US 100 ANY ST, STE 100 ANYTOWN LA (225) 999-999 RADIOLOGY USA 100 ANY ST, STE 100 ANYTOWN LA (225) 999-999 US SCAN 100 ANY ST, STE 100 ANYTOWN LA (225) 999-999 A to Z IMAGING 100 ANY ST, STE 100 ANYTOWN LA (225) 999-999 Find Provider FACILITY NAME ABC RADIOLOGY CITY ANYTOWN STATE LOUISIANA ZIP Find Clear RQI Request Step: 1 2 3 4 5 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Preferred Physi The City, State and Zip fields are optional when searching for a facility.

34. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved RQI Request Preview Health Plan: ABC Health Member Information:Referring Physician:Imaging Facility SMITH, JOHNPATEL, JOHNACME RADIOLOGY Member #: 123456789100 MEDICAL DR.,SUITE 300123 IMAGING ST., SUITE 100 123 MAIN ST., SUITE 300ANYTOWN, LA 70809ANYTOWN, LA 70809 ANYTOWN, LA 70809Phone: (225) 999-9999Phone: (225) 999-9989 Date of Birth: 01/22/1934Fax: (225) 999-9998Fax: (225) 999-9988 Exam Information: The information on the patient’s diagnosis/symptoms/conditions provided below was obtained from the referring physician and has not been independently verified by AIM. AIM assumes no responsibility for the accuracy of this information or for its consistency with the patient’s medical record. Exam CPT GroupExam Type Exam Outcome Action 1MRA Abdomen MRA Authorized Hide Details RQI Preview  RQI Manager  File Manager  Reference Desk  Profile Manager  RQI Request Summary Submit This Request Delete This Request Go to My Homepage Request Status: Has Not Been Submitted

35. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved RQI Summary  RQI Manager  File Manager  Reference Desk  Profile Manager  RQI Request Summary Begin another Request Delete This Request Go to My Homepage Print This Page RQI Summary Health Plan:Valid Date: ABC Health Case due to close On/Before 10/2/2006 Scheduled Date of Service 10/31/2006 Member Information:Referring Physician:Imaging Facility SMITH, JOHNPATEL, JOHNACME RADIOLOGY Member #: 123456789100 MEDICAL DR.,SUITE 300123 IMAGING ST., SUITE 100 123 MAIN ST., SUITE 300ANYTOWN, LA 70809ANYTOWN, LA 70809 ANYTOWN, LA 70809Phone: (225) 999-9999Phone: (225) 999-9989 Date of Birth: 01/22/1934Fax: (225) 999-9998Fax: (225) 999-9988 Exam Information: The information on the patient’s diagnosis/symptoms/conditions provided below was obtained from the referring physician and has not been independently verified by AIM. AIM assumes no responsibility for the accuracy of this information or for its consistency with the patient’s medical record. Exam CPT GroupExam Type Exam Outcome Action 1MRA Abdomen MRA Authorized Hide Details Request Status: In Progress After submitting an RQI request, your RQI summary will show a status for RQI approval

36. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Searching by RQI Number Now that you have requested and/or obtained an RQI number: You can use AIM’s to inquire on the status of your existing authorization request(s). Searching for RQIs

37. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved RQI Inquiry  RQI Manager  File Manager  Reference Desk  Profile Manager   Logoff My H RQI Request RQI Inquiry RQI Request Queue Records Per Page 10 Member Name Member Number Date of Service RQI/Status Entered Date Action SMITH, JOHN 123456789 10/03/2006 1234567 10/02/2006 Delete Total Number of Records Found: 1 Have a comment or suggestion?

38. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Member Search Results Member NameMember Number Date of Service RQI/Status Have a comment or suggestion? Search by Member ID or… Records Per Page 10 RQI Inquiry Start New Request Select Health Plan BCBSLA Select Member Search By: Member Num 1234567890 Find Clear Enter member number to view RQI summary

39. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout Member Search Results Member NameMember Number Date of Service RQI/Status Have a comment or suggestion? Search by RQI Number Records Per Page 10 RQI Inquiry Start New Request Select Health Plan BCBSLA Select Member Search By: RQI Number 123ABCD Find Clear Enter RQI number to view RQI summary

40. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved Select Member  RQI Manager  File Manager  Reference Desk  Profile Manager   Logout RQI Inquiry Member Name Member Number Relation Sex DOB Effective Date Term Date Smith, John 123456789 Employee M 01/22/1934 01/01/2006 12/31/9999 Smith, Jane 123456789 Spouse F 08/26/1938 01/01/2006 12/31/9999 RQI Inquiry Results Print This Page Delete This Request Total Number of Records Found: 2 T = Termed Member Have a comment or suggestion? ? Records Per Page 10 Select appropriate member Start New Request ABC Health Select Health Plan ABC Health Member Numb 1234567890 Find Clear

41. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved RQI Summary  RQI Manager  File Manager  Reference Desk  Profile Manager  RQI Inquiry Begin another Request Delete This Request Go to My Homepage Print This Page RQI Summary Health Plan:Valid Date: ABC Health 10/2/2006 1:28:40 PM 10/31/2006 1:28:40 PM Member Information:Referring Physician:Imaging Facility SMITH, JOHNPATEL, JOHNACME RADIOLOGY Member #: 123456789100 MEDICAL DR.,SUITE 300123 IMAGING ST., SUITE 100 123 MAIN ST., SUITE 300ANYTOWN, LA 70809ANYTOWN, LA 70809 ANYTOWN, LA 70809Phone: (225) 999-9999Phone: (225) 999-9989 Date of Birth: 01/22/1934Fax: (225) 999-9998Fax: (225) 999-9988 Exam Information: The information on the patient’s diagnosis/symptoms/conditions provided below was obtained from the referring physician and has not been independently verified by AIM. AIM assumes no responsibility for the accuracy of this information or for its consistency with the patient’s medical record. Exam CPT GroupExam Type Exam Outcome Action 1MRA Abdomen MRA Authorized Hide Details Request Status: 123ABCD Approved services have an RQI number in the RQI Status field. Also notice the Valid Date range for the RQI number.

42. Copyright © 2001-2006, American Imaging Management, Inc. All rights reserved If you have questions on using please call AIM at (866) 455-8416.