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Blue Advantage® (PPO)
Proof of Accreditation for Diagnostic Imaging

Providers who offer advanced diagnostic imaging services to Blue Advantage (PPO) members must provide proof of accreditation to Blue Cross and Blue Shield of Alabama by January 1, 2012, in order to continue to render these services and bill Blue Advantage (PPO). This is in accordance with the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA), Section 135(a), which states:

“Physicians, non-physician practitioners and independent diagnostic testing facilities providing the technical component (TC) of diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine, such as positron emission tomography (PET) services, must be accredited by January 1, 2012.”

Our Blue Advantage (PPO) plan must follow Medicare’s advanced diagnostic imaging accreditation and billing guidelines. Providers who currently participate in Blue Cross and Blue Shield of Alabama’s Preferred Radiology Program (PRP) will not be required to submit proof of accreditation. However, if you participate in the PRP and have a nuclear medicine accreditation, you must submit proof of that accreditation.

Accreditation does not apply to the professional component (26) of the imaging procedure and hospitals are excluded. The accreditation organizations approved by the Centers for Medicare & Medicaid Services (CMS) are the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission. For a list of procedures that will require accreditation go to:

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/AdvancedDiagnosticImagingAccreditation.html

You can mail, fax or email the accreditation documentation to:

Blue Cross and Blue Shield of Alabama Telephone: 205-220-6765
Attention: Provider Credentialing Fax: 205-220-9545
Post Office Box 362142 Email: credentialing@bcbsal.org
Birmingham, Alabama 35236-2142  

If you have any questions concerning your participation in the Blue Advantage (PPO) program, contact your Provider Network Services Representative toll free at 1-866-904-4130.

Be sure your entire staff knows you are a Blue Advantage (PPO) participating provider.

Blue Advantage (PPO) is a Medicare-approved PPO Plan.

Last Updated March 2012