Effective for dates of service on and after March 9, 2019, the following updates will apply to all of AIM’s Clinical Appropriateness Guidelines, including Advanced Imaging, Cardiac, Sleep, Radiation Oncology and Musculoskeletal guidelines. 

 

Clinical appropriateness framework

Replacing pretest requirements, this section will more accurately describe the guideline’s purpose, which is to provide a summary of the fundamental components of a decision to pursue diagnostic testing.  In order to support the full spectrum of AIM solutions, the terms “imaging request” or “diagnostic imaging” are replaced with “diagnostic or therapeutic intervention”.

 

Ordering of multiple diagnostic or therapeutic interventions

Replacing ordering of multiple studies, this section expands its applicability to AIM solutions outside of diagnostic imaging.  Terminology specific to imaging studies is replaced with the term “diagnostic or therapeutic intervention” to reflect a broader application of the principles included here. 

 

Repeat diagnostic testing and repeat therapeutic intervention

Replacing repeated imaging, these sections establish conditions in which duplication of the initial test or intervention may be warranted, and where such requests will require peer-to-peer discussion. 

 

As a reminder, ordering and servicing providers may submit prior authorization 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 www.availity.com.
  • Call the AIM Contact Center toll-free number at 866-714-1107, Monday–Friday, 8:00 a.m.–5:00 p.m.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines here.

 



Featured In:
December 2018 Anthem New Hampshire Provider Newsletter