Effective for dates of service on and after January 28, 2019, the following updates will apply to the AIM Specialty Health© (AIM) radiation oncology clinical appropriateness guidelines. AIM is a separate company.

 

Breast cancer

  • Removed age and tumor size criteria for accelerated whole breast irradiation (AWBI)

 

Rectal cancer

  • Modified criteria no longer limits treatment with intensity modulated radiation therapy (IMRT) for rectal adenocarcinoma

 

Pancreatic cancer

  • Added criteria for stereotactic body radiation therapy (SBRT) in treating locally advanced or recurrent disease without evidence of distant metastasis

 

Head and neck cancer

  • Added criteria to allow IMRT for head and neck lymphomas
  • Clarified no IMRT for stage I/II glottic cancer

 

Lung cancer

  • Added dose volume histogram (DVH) parameter for cardiac V50

 

Sarcoma

  • Removed preoperative and joint sparing requirements for IMRT

 

Prostate cancer

  • Added discussion on hypofractionation
  • Added discussion on brachytherapy

 

As a reminder, ordering and servicing providers may submit pre-service clinical review requests to AIM in one of several ways:

 

  • Access AIM’s 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 Web Portal at availity.com.
  • Call the AIM Contact Center toll-free number: 866-714-1107, 8:00 a.m. – 5:00 p.m.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines on AIM’s website.

 

Please note, this program does not apply to the Federal Employee Program® (FEP®) or National Accounts.



Featured In:
October 2018 Anthem Connecticut Provider Newsletter