Chiropractic Quality Initiative Program
Provider Administrative Policy
Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts
The Chiropractic Quality Initiatives Program and its supporting quality improvement processes are designed and managed by Alternative Medicine Integration of Idaho (AMI) for Blue Cross of Idaho to continuously improve the quality of clinical care and services provided to our members from participating chiropractors.
Effective September 1, 2011, Blue Cross of Idaho required providers to enter provider and patient data into the AMI Clinical Outcome Management System (ACOMSSM) on all current and future patient episodes of care. Effective August 1, 2014 The ACOMSsm system will be replaced by IMDISTM (Integrated Medical Data Information System). On July 31, 2014 the ACOMS system will no longer be in use.
You are required to gather the data via patient questionnaire(s), provider treatment notification forms and enter it both at the initial patient visit and at monthly follow ups for the duration of the episode of care. The intent of this program is to provide the chiropractic community and Blue Cross of Idaho with a tool to compare specific chiropractic treatment patterns with nationally established, evidence based guidelines.
To Access AMI's Quality Initiative Program Portal:
- Go to: bcidaho.com
- Select Providers/Medical
- Log on using your username and password
- Select Chiropractic Management
If you don't currently have access to bcidaho.com, please contact your external provider relations representative listed in PAP100.
Recommended Course of Treatment
Upon completion of entering the required data into IMDIS, both initially and on a monthly basis, providers will receive a recommended course of treatment based on Nationally Accepted Guidelines, specifically the Official Disability Guidelines (ODG) and the Chiropractic Council on Chiropractic Guidelines and Practice Parameters (CCGPP) including:
- Maximum number of recommended visits and duration of care
- All services inside and outside Nationally Accepted Treatment Guidelines for associated diagnoses
- Detailed Nationally Accepted Treatment Guideline reference for each diagnosis
- Severity rated maximum number of recommended visits
Blue Cross of Idaho and AMI will retrospectively compare the recommended course of treatment and submitted claims. Analysis reports are then matched with the provider/patient episode of care in the IMDIS system. This report will show detailed information regarding how the care received compares to the Nationally Accepted Treatment Guidelines, and the percentage of episodes, visits and services billed within and outside of the Nationally Accepted Treatment Guidelines. The report is available within IMDIS so your clinic can view or print it at any time. If an insured's condition is not improving based on a pre-determined minimal improvement standard, IMDIS will notify you after logging in to view the specific episodes of care for lack of clinical improvement or excessive services outside of Nationally Accepted Treatment Guidelines.
Chiropractic services that are not medically necessary may be submitted with a GA modifier once a signed ABN is obtained from the member. Such services will be member liability. (See PAP248)
AMI of Idaho Contact Information
Providers may contact AMI of Idaho at (855-432-2667). AMI provider representatives are happy to answer general questions about the Blue Cross of Idaho Chiropractic Quality Initiative Program. Specific questions regarding IMDIS and the Nationally Accepted Treatment Guidelines may be answered through the AMI portal of the Blue Cross of Idaho website or by calling the AMI IMDIS Provider Support Team at 855-464-6347.
The following Blue Cross of Idaho groups do not require patient documentation entry into IMDISTM as described in this policy. Please refer to PAP102 for a listing of the alpha prefixes for the following products.
- Medicare Supplements
- Medicare Advantage (True Blue and Secure Blue)
- Federal Employee Program
- BlueCard members
- State of Idaho employees
When Blue Cross of Idaho is Secondary
Patient documentation is not required when Blue Cross of Idaho is the payer of secondary coverage. If the patient is showing in the IMDIS system, but the treating provider's patient coverage records indicate that Blue Cross of Idaho should be secondary, please notify Blue Cross of Idaho provider representatives while continuing to enter patient information to avoid possible non-compliance in the event the patient is truly primary. (See PAP100) All services, whether primary or secondary, may be subject to medical necessity review.
Tax Identification Changes for Clinic
When a clinic changes their Tax Identification they must notify the appropriate provider representative. (See PAP230). This will ensure IMDIS is flagged to merge the provider's login with all previous system entries.
|August 2014||Revised||ACOMS to IMDIS updates|
|November 2012||Revised||Added language to When Blue Cross is Secondary.|
|June 2012||Revised||Added section regarding Tax Identification Changes for Clinic|
|September 2011||Revised||Added excluded groups.|