Notification of preapproval list changes 8/1/18

Preapproval changes are listed in the attachment.  For additional information, you can access the complete Georgia Standard Preapproval List, Georgia Standard Preapproval CODE List and Georgia Standard Adopted Clinical Guideline List using the following links:

• 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 ProviderPortal_sm 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)    

For more details on these programs, please visit the AIM Specialty Health® site at aimspecialtyhealth.com/marketing/guidelines/185/index.html. By clicking on the link above, you will be linked 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.

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.