Effective November 1, 2020, the AIM Musculoskeletal Program will be expanded to include medical necessity reviews for certain elective surgeries of the small joints for Anthem members. AIM Specialty Health® (AIM) will perform the expanded musculoskeletal program and will review certain lower extremity small joint surgeries for clinical appropriateness of the procedure and the setting in which the procedure is performed (level of care review). The clinical guidelines adopted by Anthem and used by AIM to review for medical necessity and level of care are located here: AIM Small Joint Surgery Guideline and AIM Level of Care Guidelines for Musculoskeletal Surgery and Procedures.

 

AIM will begin accepting prior authorization requests on October 26, 2020, for dates of service on and after November 1, 2020. To determine if prior authorization is required, please call the prior authorization number located on the back of the member’s ID card. 

 

Members included in the new program

All fully insured and administrative services only (ASO) members currently participating in the AIM Musculoskeletal Program are included. For ASO groups that currently do not participate in the AIM Musculoskeletal Program, the program will be offered to ASOs to add to their members’ benefit package as of November 1, 2020.

 

Pre-service review requirements

For surgeries scheduled to begin on or after November 1, 2020, all providers must contact AIM to obtain prior authorization for the following non-emergency modalities:

 

Small joint replacement (including all associated revision surgeries)

  • Total joint replacement of ankle
  • Correction of Hallux Valgus
  • Hammertoe repair

 

Surgeries performed as part of an inpatient admission are included. 

 

To place a review request:

  • Online: Get fast, convenient online service via the AIM ProviderPortalSM. ProviderPortal is available twenty-four hours a day, seven days a week, processing requests in real-time using clinical criteria. Go to aimspecialtyhealth.com/goweb to register. 

 

For more information:

Go to www.aimprovider.com/msk for resources to help your practice get started with the musculoskeletal and pain management program. Our website provides access to helpful information and tools such as order entry checklists, clinical guidelines and FAQs.

 

We value your participation in our network and look forward to working with you to help improve the health of our members.

 

571-0820-PN-NE



Featured In:
August 2020 Anthem New Hampshire Provider News