The AIM Advantage

• In-Depth Experience: AIM has over 10 years of experience in processing, adjudicating and paying imaging claims in several markets. AIM experience includes: managing claims for both low-tech and high-tech services, administering a broad range of payment methodologies and servicing both AIM and health plan contracted providers.
• Dedicated and Broad Staff Expertise: AIM has a dedicated claims staff with a broad range of expertise including: claims processing, information technology, coding, finance, customer services, provider relations, and reporting.
• Focused Diagnostic Imaging Claim System: AIM has a proprietary imaging claim system. AIM’s ability to focus its system development efforts on imaging claims ensure that payment parameters are aligned with currently accepted payment practices.
• Proven Results: With over 4,000 imaging claims paid per day, AIM’s experience, technology and expertise offer excellent results to health plans in key metrics such as turnaround time, ability to accept EDI transactions and payment accuracy.
  

The Need for Payment Accuracy in Imaging

As the imaging environment continues to evolve, health plans need to be able to ensure accurate and timely payment for these services. Changes to accepted payment methodologies, such as those contained in the Deficit Reduction Act, can happen frequently and can produce a material impact for health plans if they are able to take advantage of them. Conversely, as imaging providers become more sophisticated in their billing practices, health plans need to be able to monitor, evaluate and assess claim submissions in order to ensure accurate payment based on health plan payment rules and provider contracts. These factors, along with the inherent complexity of health plan claim systems, can make it difficult for health plans to adjust in a timely manner to ensure optimal payment practices.

The AIM Approach to Transaction Validation

With over one million imaging claims processed annually, AIM’s Transaction Validation capabilities offer a proven alternative for the processing, adjudication, payment and reporting of imaging claims. AIM works collaboratively with its health plan clients to develop a Transaction Validation program that requires minimal system changes by the health plan and delivers timely and accurate payment for imaging providers. AIM’s experience and expertise provide the flexibility needed to process claims across a variety of situations including the following:

• Multiple Payment Methodologies: AIM proprietary claim systems can administer a broad range of payment methodologies including: capitation, fee-for-service, percent of CMS fee schedules, and episode of care for specialists.
• Multiple Products and Networks: AIM can administer different payment rules for providers, even those providers that participate in multiple health plan networks (e.g. PPO, HMO, POS, etc.). AIM can administer claims for providers that contracted by the health plan, by AIM (through a Full Risk arrangement) or through a third-party (e.g. rental PPO).
• Multiple Network Rules: AIM can administer any privileging or authorization requirements determined by the health plan.
• Multiple Submission and Payment Methods: AIM can receive claims either via paper or EDI. Currently, over 70% of claims received by AIM are sent via EDI. AIM can issue payment via paper check or Electronic Funds Transfer (“EFT”). All payments include an Explanation of Benefits.

AIM’s ability to administer complex payment arrangements is made possible through its proprietary imaging claim system and a dedicated staff that includes expertise in key areas such as: claims processing, information technology, coding, finance, customer services, provider relations, and reporting. Through a clear and dedicated focus on imaging claims, AIM is able to produce excellent results:

• Average Turnaround Time less than 15 days
• Audited Payment Accuracy rates between 96% and 100%
• Captured payment accuracy advantage of 2% to 4% compared to health plan payments
  

The Value of AIM’s Approach to Transaction Validation

AIM’s approach to Transaction Validation provides health plans with the opportunity to achieve improved payment strategies for their imaging provider network. Through dedicated staff and systems, AIM delivers excellent results to health plans and their providers.