What’s Changing?
The utilization management vendor that manages certain outpatient prior authorizations for some members in the plans listed below will be AIM Specialty Health® (AIM) effective Jan. 1, 2021:
- Blue Choice PPOSM
- Blue EssentialsSM and Blue Essentials AccessSM
- Blue PremierSM and Blue Premier AccessSM
- Blue Advantage HMOSM
- MyBlue HealthSM
- Blue High Performance NetworkSM (New plan effective Jan. 1, 2021)
(Note: There are no changes to the vendors for BCBSTX Government Programs (Medicare Advantage and Medicaid plans).
What’s Not Changing?
The care categories and procedure codes that currently require prior authorization will stay the same* as the previous vendor:
- Advanced imaging**
- Cardiology
- Sleep medicine
- Pain management
- Joint and spine surgery
- Radiation therapy
- Genetic testing
* Exception are updates for new, replaced or removed procedure codes that may occur to comply with American Medical Association or Centers for Medicare & Medicaid Services or other industry-standard entities.
**The AIM Radiology Quality Initiative program (RQI) for Blue Choice PPO members will continue for members that do not require an advanced imaging prior authorization.
You can find code lists for the services that require prior authorization on our provider website.
Check which members and services need prior authorization
Use Availity® or your preferred vendor or call the number on the back of the ID card to:
- Check eligibility and benefits
- Determine if you’re in-network for your patient
- Find out if the patient and services require prior authorization or a RQI prenotification
- Learn whether prior authorization is required for a procedure code and who to contact
How can you prepare?
Make sure you have an account with AIM. To create an account:
- Access the AIM ProviderPortal, or
- By Phone – Call the AIM Contact Center at 1-800-859-5299 Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays.
If you are already registered with AIM, you do not need to register again.
Submit prior authorization requests to AIM. when applicable, for Jan. 1, 2021, in one of the following ways:
- Online – Submit requests via the AIM ProviderPortal 24/7.
- By Phone – Call the AIM Contact Center at 1-800-859-5299 Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays.
If benefit prior authorization is required, services performed without benefit prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
Look for future news and updates on upcoming training and FAQs that will provide all of the important information you need regarding AIM.
If you have any questions, you may contact your Network Management Representative.
AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.