As previously communicated in the October 2017 Network Update, Anthem Blue Cross (Anthem) uses AIM to administer pre-service clinical reviews for services noted below.  AIM reviews requests in real time against evidence-based clinical guidelines and Anthem medical policies.  Providers are notified via letter or remit message when claims are submitted without the appropriate pre-service review by AIM.  If such a letter or message is received, providers will need to obtain a post-service clinical review for the service via the AIM ProviderPortalSM.  If documentation/post–service review request is submitted to Anthem, Providers are notified via another letter or remit message to submit to AIM.

 

To help prevent delays in claim processing and post-service reviews, ordering providers submit pre-service request to AIM in one of the following ways:

  • Access AIM ProviderPortal directly at providerportal.com available 24/7 to process orders in real-time
  • Access AIM via the Availity web portal at availity.com
  • Call the AIM Contact Center toll-free number: 1-877-291-0360, Monday–Friday, 7:00 a.m.–5:00 p.m. PT.


As a reminder, AIM reviews the following services for clinical appropriateness:

  • Advanced diagnostic imaging
  • Cardiology tests and procedures (e.g. MPI, echocardiography, PCI, cardiac catheterization)
  • Medical oncology treatments through the Cancer Care Quality Program
  • Radiation oncology treatments (e.g. IMRT, brachytherapy)
  • Sleep testing, treatment and supplies
  • Genetic testing
  • Musculoskeletal (e.g., spine and joint surgeries, pain management)
  • Surgical Site of Care (e.g., gastroenterology, other surgeries will be implemented which will be communicated via our provider newsletter) – effective December 1, 2020


Services performed in an emergency or inpatient setting are excluded from AIM programs.

This update applies to local fully-insured Anthem members and members who are covered under a self-insured (ASO) benefit plan, with services medically managed by AIM. It does not apply to HMO, BlueCard®, Medicare Advantage, Medicaid, Medicare Supplement, Federal Employee Program® (FEP®).

For more information please contact the phone number on the back of the member ID card.


711-1120-PN-CA



Featured In:
November 2020 Anthem Blue Cross Provider News - California