Preapproval list change notification August 1, 2022 (MAC)

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 logging onto Availity.com. From the Patient Registration tab, run an Eligibility and Benefits Inquiry. Service preapproval is based on a 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 the verification of member eligibility and covered benefits. Except in the case of an emergency, failure to obtain approval prior to rendering the designated services listed above will result in denial of reimbursement.

 

The following services will be added to prior authorization for GA local members. Items marked with an ‘*’ may be reviewed by AIM.

 

Add to preapproval
DME.00046 Intermittent Abdominal Pressure Ventilation Devices	K1021	Add November 1, 2022
DME.00047 Rehabilitative Devices with Remote Monitoring	E1399	Add November 1, 2022
DME.00048 Virtual Reality-Assisted Therapy Systems	E1399	Add November 1, 2022
GENE.00059* Hybrid Personalized Molecular Residual Disease Testing for Cancer	81479	Add November 1, 2022
LAB.00048 Pain Management Biomarker Analysis	0117U	Add November 1, 2022
MED.00139 Electrical Impedance Scanning for Cancer Detection	99199	Add November 1, 2022
TRANS.00039 Portable Normothermic Organ Perfusion Systems	32299, 47399, 33999, 53899	Add November 1, 2022
Codes added to existing preapproval documents
CG-SURG-61 Cryosurgical, Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver	0673T, 61736, 61737, 60999	Add November 1, 2022
GENE.00023* Gene Expression Profiling of Melanomas and Cutaneous Squamous Cell Carcinoma	0315U	Add November 1, 2022

 

GABCBS-CM-002875-22