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March/April 2009

Blue Cross Blue Shield of Michigan

Radiology Management Program compliance program continues to improve
Hospital radiology preauthorization compliance scores for BCBSM's PPO Radiology Management Program continued to show improvement throughout the 2008 year. The 2008 overall compliance average score is 85% compared to our baseline of 53% in 2005.

In 2008, we mailed out quarterly letters outlining hospital compliance with BCBSM's Radiology Management Program. This program, administered by American Imaging Management, requires the prior authorization of nonemergency CT, MRI and PET scans and certain nuclear imaging procedures. As you recall we identified a data issue in the first quarter 2008 data with PET imaging and secondary codes, as a result and resolution we no longer consider secondary procedures and coordination of benefits claims in the compliance data.

While the ordering physician is responsible for obtaining authorization for these procedures, the scores indicate hospitals, and physicians are working together to preauthorize radiology procedures.

The chart below compares the overall number of hospital in each compliance range for preauthorizing the specified procedures during the 2008 year.

Overall, statewide hospital compliance data has continued to improve and we appreciate the effort of our hospitals and physicians to improve the overall scores. We are close to our goal of 90%. To keep this trend going, we ask each hospital to continue to use the compliance scores as a guide given these quarterly scores are based on claims incurred and paid during the quarter. Your BCBSM provider consultant will share your fourth quarter 2008 individual hospital's compliances rates with you.

Hospital Outpatient Radiology Compliance Report
Compliance Range 1st Quarter 2008 2nd Quarter 2008 3rd Quarter 2008 4th Quarter 2008
  No. of hospitals in range Percent of hospitals in range No. of hospitals in range Percent of hospitals in range No. of hospitals in range Percent of hospitals in range No. of hospitals in range Percent of hospitals in range
0%-10% 4 3% 3 2% 2 1% 1 1%
11%-20% 4 3% 2 1% 3 2% 1 1%
21%-30% 1 1% 4 3% 0 0% 1 1%
31%-40% 3 2% 2 1% 1 1% 1 1%
41%-50% 4 3% 6 4% 3 2% 4 3%
51%-60% 4 3% 5 4% 6 4% 1 1%
61%-70% 15 11% 6 4% 3 2% 6 4%
71%-80% 20 15% 16 12% 19 14% 9 7%
81%-90% 45 33% 57 41% 47 34% 43 31%
91%-100% 37 27% 38 27% 54 34% 571 51%
Total 137 100% 139 100% 138 100% 138 100%
Overall compliance Average 81% 84% 87% 89%
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