California
Provider Communications

Aug 16, 2018 • Policy Updates / Medical Policy & Clinical Guidelines

In December 2017, Anthem Blue Cross (Anthem) announced the implementation of a new AIM musculoskeletal program. Following the initial announcement, the program was delayed. This notice is to provide an update about the program, which will be effective on August 15, 2018 2018 (NOTE: Provider notification via US mail states August 1, 2018, which has subsequently been delayed). Should the program be further delayed, updates will be accessible to providers on Availity and AIM portals. Additional information about the program is provided below for ease of reference. 

Beginning with dates of service on and after August 15, 2018, AIM Specialty Health® (AIM), a separate company, will perform prior authorization review of certain surgeries of the spine and joints, interventional pain treatment, level of care/setting, pre-operative days, and expected length of stay to determine medical necessity for Anthem members. AIM clinical guidelines have been adopted by Anthem and will be used to conduct these reviews. All codes and clinical guidelines included in the musculoskeletal program can be found on the AIM MSK website.

Providers can now submit prior authorization requests for dates of service on and after August 15, 2018, to AIM in one of the following ways:

• Access AIM ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
• Access AIM via the Availity Portal at availity.com
• Call the AIM toll-free number at 1-877-291-0360, Monday through Friday 5:00 am – 4:00 pm PT.

Benefits and requirements may vary by health plan, so providers should continue to verify eligibility and benefits for all members prior to rendering services. For questions, please contact the provider number on the back of the member ID card.