Inclusion of AIM-reviewed services in UM reimbursement penalties
Anthem Blue Cross and Blue Shield (Anthem) requires prior authorization prior to the delivery of certain elective services in both the inpatient and outpatient settings. As previously communicated in Provider News, most late prior authorizations are currently subject to a payment reduction to the Provider and Facility in accordance with your provider contract. This penalty has not been applied to services requiring prior authorization by AIM Specialty Health (AIM). Effective for claims processed after October 17, 2020, Anthem will apply the payment reduction penalty for failure to comply with the prior authorization requirements to services reviewed by AIM for commercial plan members.
As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
- Access to 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 at 800-554-0580, Monday through Friday, 8:30 a.m. to 7:00 p.m. Eastern time.
September 2020 Anthem Provider News - Ohio