Effective November 1, 2020, AIM Specialty Health® (AIM), a specialty health benefits company, will expand the AIM Musculoskeletal program to perform medical necessity reviews for certain elective surgeries of the small joints for Anthem Blue Cross members, as further outlined below.  AIM works with leading insurers to improve healthcare quality and manage costs for today’s most complex and prevalent tests and treatments, helping to promote care that is appropriate, safe and affordable. 

 

The expanded musculoskeletal program will review certain lower extremity small joint surgeries for clinical appropriateness of the procedure and the setting in which the procedure is performed (Level of Care review). The clinical guidelines that have been adopted by Anthem to review for medical necessity and level of care are located here: AIM Small Joint Surgery Guideline and AIM Level of Care Guidelines for Musculoskeletal Surgery and Procedures. AIM will begin accepting prior authorization requests on October 26, 2020 for dates of service on and after November 1, 2020. To determine if prior authorization is needed for an Anthem member, please call the number located on the back of the member’s ID card. 

 

Members included in the new program

All FI and ASO members currently participating in the AIM Musculoskeletal program are included. For self-funded (ASO) groups that currently do not participate in the AIM Musculoskeletal program, the program will be offered to self-funded accounts (ASO) to add to their members’ benefit package as of November 1, 2020.

 

Pre-service review requirements

For surgeries that are scheduled to begin on or after November 1, 2020, all providers must contact AIM to obtain prior authorization review for the following non-emergency modalities:

 

Small Joint replacement (including all associated revision surgeries)

  • Total joint replacement of ankle
  • Correction of Hallux Valgus
  • Hammertoe repair

 

Surgeries performed as part of an inpatient admission are included. 

 

How to place a review request:
Online:
Get fast, convenient online service via the AIM ProviderPortalSMProviderPortal is available twenty-four hours a day, seven days a week, and process requests in real-time using clinical criteria. Go to aimspecialtyhealth.com/goweb to register. Registration opens February 19, 2018. 

By phone:
Call AIM Specialty Health toll-free at (866) 714-1103, Monday through Friday 8:30 a.m.–7:00 p.m. (ET). Registration opens February 19, 2018.

 

For more information:

Go to aimprovider.com/msk for resources to help your practice get started with the musculoskeletal and pain management program.  Our special website helps you learn more and access helpful information and tools such as order entry checklists, clinical guidelines, FAQs.

 

You can also contact your local Network Relations Representative.

 

We value your participation in our network and look forward to working with you to help improve the health of our members.

 

571-0820-PN-GA

 



Featured In:
August 2020 Anthem Provider News - Georgia