AmeriHealth New Jersey, in collaboration with AIM Specialty Health^SM (AIM), is collecting information about the imaging capabilities of all AmeriHealth-contracted providers in New Jersey who perform the technical component of advanced diagnostic imaging services (CT/CTA, MRI/MRA, nuclear cardiology, and PET scans) for AmeriHealth New Jersey members.

Starting June 1, 2012, the information regarding imaging capabilities and average cost values for the combined professional and technical components will be made available to physicians who submit a request for an advanced diagnostic imaging service for their AmeriHealth New Jersey patients.

Ordering physician transparency

Ordering physicians can request precertification for advanced diagnostic imaging services through the NaviNet? web portal by selecting AIM from the Authorizations option in the Plan Transactions menu. Starting June 1, 2012, when ordering physicians request precertification online for AmeriHealth New Jersey members, a table will be presented that includes the scores and cost information for local imaging providers.

Please note that this table will only be viewable to ordering physicians after they have reached the provider selection portion of the precertification request process. In addition, cost information or modality scores may not be available in some instances. When this occurs, a dash will be displayed in applicable columns.

Member engagement

Using the cost and facility data, AIM will also engage AmeriHealth New Jersey members in the site selection process. Once a precertification request has been received for advanced diagnostic imaging services, AIM specialists will proactively reach out to members to inform them of the imaging facility options available to them. During this outreach, members can potentially reduce their health care expenses (e.g., cost-sharing) by selecting a different facility that is high-quality and low-cost.

Please note that members will not be denied access to services if they do not choose a higher quality or lower cost option. Our goal is simply to provide them with information to make informed choices about their health care.

Registration and completion of the assessment can be done through OptiNet®

AIM uses an online assessment tool, called OptiNet, through which they collect modality-specific data, including facility qualifications, technologist and physician qualifications, accreditation, equipment, and technical registration. This information is used to assess compliance to industry-recognized standards, including those established by the American College of Radiology and the Intersocietal Accreditation Commission.

We ask that all participating providers in New Jersey who perform the technical component of advanced diagnostic imaging services complete an online assessment through OptiNet by May 31, 2012. The data provided will become an important part of the information available to ordering physicians and members. If you are a servicing provider who performs advanced imaging services and you do not complete an assessment, your facility information will not be available to ordering physicians or patients.

The OptiNet assessment tool was designed with your convenience in mind:

• OptiNet is available online through NaviNet. Select AIM from the Authorization option in the Plan Transactions menu, then Access Your OptiNet Registration. Click on the green button to launch OptiNet.
• You can save your data as you go, which means you do not need to complete the assessment in one sitting.
• A checklist of the information required is available on the AIM ProviderPortal^SM. Select the File Manager tab and then Forms.
• After you complete the assessment, you can update your information at any time.

Please note that if you have already completed the assessment in OptiNet in connection with another health plan, you do not need to re-enter your information. Please review the information that has been prepopulated, make any necessary updates, and submit your information to register for AmeriHealth New Jersey.

If you have multiple facilities, it is important that you complete an assessment for each one. However, you do not need to re-enter your information, as you can complete the OptiNet registration for one facility and copy your data for the others. To copy your data, select Copy from the Actions column on your site list and follow the steps when prompted.

If you have questions or need help completing the assessment, call AIM OptiNet Customer Service at 1-800-252-2021.

How the assessment information will be used

Upon the completion of the assessment, your responses will be evaluated using the OptiNet algorithm, and a modality score (represented by a letter grade) will be assigned to each of your facility's services based on the following scale:

• A = 88 ? 100 points
• B = 76 ? 87 points
• C = fewer than 76 points

Your facility's modality score, the average allowed payment amount (based on the professional and technical components of previously billed services), and the distance from members' homes will be shared with ordering physicians and their AmeriHealth New Jersey patients to assist them in making important health care decisions regarding advanced diagnostic imaging services.

Please be sure to review the score legend and the Understanding Your Score Card document, which are available at the top of your online score card. These reference documents outline the specific measures against which your site has been evaluated and will identify which areas may be deficient.

If you have any questions or concerns about this new transparency effort or about completing your assessment, please contact your Network Coordinator.

NaviNet® is a registered trademark of NaviNet, Inc.