Reminder: Updated AIM Musculoskeletal Program site of care reviews effective November 1, 2021
As previously communicated in the August edition of Anthem Blue Cross and Blue Shield’s (Anthem) Provider News, effective November 1, 2021, AIM Specialty Health® (AIM), will expand the AIM Musculoskeletal program to perform medical necessity review of the requested site of service for certain joint and interventional pain procedures for Anthem fully-insured members, as outlined below.
AIM will continue to manage the AIM Musculoskeletal program and level of care review. The AIM Level of Care Guideline for Musculoskeletal Surgery and Procedures is used for the level of care review. Prior authorization will now also be required for the clinical appropriateness of the site in which the procedure is performed (site of care). A subset of the AIM musculoskeletal program codes will be reviewed for site of care. A complete list of CPT codes requiring prior authorization for the AIM Musculoskeletal site of care program is available on the AIM Musculoskeletal microsite. AIM will use the following [BRAND] Clinical UM Guideline: CG-SURG-52: Site of Care: Hospital-Based Ambulatory Surgical Procedures and Endoscopic Services. The clinical criteria to be used for these reviews can be found on the Anthem Provider portal Clinical UM Guidelines page. Please note, this does not apply to procedures performed on an emergent basis.
Members included in the new program
All Commercial fully-insured members currently participating in the AIM Musculoskeletal program are included.
Pre-service review requirements
For services that are scheduled to begin on or after November 1, 2021, providers may contact AIM to obtain prior authorization review beginning October 18, 2021. The following groups are excluded: Medicare Advantage, Medicaid, Medicare, Medicare supplement, MA EGR, and the Federal Employee Program® (FEP®).
Providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortallSM 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 Web Portal at availity.com.
- Call the AIM Contact Center toll-free number at 877-291-0366, Monday – Friday, 8:00 a.m. – 6:00 p.m. MT.
AIM Musculoskeletal training webinars
Anthem invites you to take advantage of a free informational webinar that will introduce you to the program and the robust capabilities of the AIM ProviderPortalSM. Go to the AIM Musculoskeletal microsite to register for an upcoming webinar. If you have previously registered for other services managed by AIM, there is no need to register again.
We value your participation in our network and look forward to working with you to help improve the health of our members.
October 2021 Anthem Provider News and Important Updates - Colorado