Notification of preapproval list changes 8/1/18
- Georgia Standard Preapproval List
- Georgia Standard Preapproval CODE List
- Georgia Standard Adopted Clinical Guideline List
AIM Specialty Health®
AIM Specialty Health, a separate company, is a nationally recognized leader delivering specialty benefits management on behalf of GA for certain health plan members. Determine if preapproval is needed for a GA member by clicking the “Medical Policy, Clinical UM Guidelines, and Preapproval Requirements” link on our provider website or by calling the preapproval 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 ProviderPortalsm 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
- Outpatient Sleep Testing and Therapy Services
- Specialty Pharmacy Drugs
- Cancer Care Quality Program
- Musculoskeletal (effective date yet to be determined)
- Upper Gastrointestinal Endoscopy (effective 11/1/2018)
New AIM Musculoskeletal (MSK) Program - Delay in launch for Fully Insured - effective date yet to be determined
The December 2017 edition of the Network Update announced that AIM Specialty Health® (AIM), a separate company, would perform prior authorization reviews of certain surgeries of the spine and joints, as well as interventional pain treatment to determine medical necessity for fully insured BCBSGA members. Please be aware that this program has been delayed. The new implementation date is yet to be determined.
The new musculoskeletal program includes review of the level of care/setting, pre-operative days, and expected length of stay for medical necessity using AIM clinical guidelines which have been adopted by BCBSGA. All codes and clinical guidelines included in the musculoskeletal program can be found on the AIM MSK website.
Eligibility and benefits
Eligibility and benefits can be verified by accessing the BCBSGa/BCBSHP web site bcbsga.com 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.
See attachment to view a list of preapproval changes.
August 2018 BCBSGa Provider Newsletter