Material adverse change (MAC)

 

AIM Specialty Health®

AIM Specialty Health®, a separate company, is a nationally recognized leader delivering specialty benefits management on behalf of Anthem for certain health plan members. Determine if prior authorization is needed for a Georgia Anthem member by visiting the “Medical Policy and Clinical UM Guidelines” page on our provider website or by calling the prior authorization phone number printed on the back of the member’s ID card. To submit your request for any of the services below, contact AIM online via AIM’s website at aimspecialtyhealth.com/goweb. From the drop-down menu, select GA. You may also call AIM toll-free at 866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET

 

AIM provides benefits management for the programs listed below:

  • Imaging level of care
  • Genetic testing
  • Diagnostic imaging management
  • Cardiovascular services
  • Radiation therapy services
  • Rehabilitative services
  • Outpatient sleep testing and therapy services
  • Cancer care quality program
  • Musculoskeletal (for fully insured)
  • Upper gastrointestinal endoscopy in adults, and site of care for certain surgical services


For more details on these programs, please visit the AIM website. Clicking the previous links will direct you to sites created and/or maintained by another, separate entity (“external site”). Upon linking, you are subject to the terms of use, privacy, copyright and security policies of the external sites. We provide these links solely for your information and convenience. We encourage you to review the privacy practices of the external sites. The information contained on the external sites should not be interpreted as medical advice or treatment provided by us.

 

Eligibility and benefits

Verify eligibility and benefits on anthem.com/provider or by calling the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits. Except in the case of an emergency, failure to obtain preapproval prior to rendering the designated services listed below will result in denial of reimbursement.

Add to preapproval

LAB.00040

Serum Biomarker Tests for Risk of Preeclampsia

0243U

Add 1/1/2022

OR-PR.00007

Microprocessor Controlled Knee-Ankle-Foot Orthosis

L2006

Add 1/1/2022

CG-SURG-63

Cardiac Resynchronization Therapy with or without an Implantable Cardioverter Defibrillator for the Treatment of Heart Failure

 

33228, 33229, 33263, 33264

Add 1/1/2022

 

 

1331-1021-PN-GA



Featured In:
October 2021 Anthem Provider News - Georgia