AIM Specialty Health radiation oncology clinical guidelines updates
Effective for dates of service on and after January 28, 2019, the following updates will apply to the AIM Specialty Health© (AIM) radiation oncology clinical appropriateness guidelines. AIM is a separate company.
- Removed age and tumor size criteria for accelerated whole breast irradiation (AWBI)
- Modified criteria no longer limits treatment with intensity modulated radiation therapy (IMRT) for rectal adenocarcinoma
- Added criteria for stereotactic body radiation therapy (SBRT) in treating locally advanced or recurrent disease without evidence of distant metastasis
Head and neck cancer
- Added criteria to allow IMRT for head and neck lymphomas
- Clarified no IMRT for stage I/II glottic cancer
- Added dose volume histogram (DVH) parameter for cardiac V50
- Removed preoperative and joint sparing requirements for IMRT
- Added discussion on hypofractionation
- Added discussion on brachytherapy
As a reminder, ordering and servicing providers may submit pre-service clinical review requests to AIM in one of several ways:
- Access AIM’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
- Access AIM via the Availity Web Portal at availity.com.
- Call the AIM Contact Center toll-free number: 866-714-1107, 8:00 a.m. – 5:00 p.m.
For questions related to guidelines, please contact AIM via email at firstname.lastname@example.org. Additionally, you may access and download a copy of the current guidelines on AIM’s website.
Please note, this program does not apply to the Federal Employee Program® (FEP®) or National Accounts.
October 2018 Anthem Maine Provider Newsletter