In the June newsletter we announced the transition of the medical non-oncology specialty drug review process from AIM Specialty Health® (AIM) to Anthem Blue Cross and Blue Shield (Anthem)’s medical specialty drug review team, effective June 15, 2019. Here’s a reminder of the changes.

 

What has changed?

  • Beginning June 15, 2019 all requests, regardless of service date, providers need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team:
    • o by phone at 1-833-293-0659 or
    • o by fax at 1-888-223-0550 or
    • o Online access at Availity.com available 24/7.
  • All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration are being managed by Anthem’s medical specialty drug review team.

 

What has not changed?

  • AIM continues to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
  • Clinical criteria for medical non-oncology specialty drugs continues to reside on the Clinical Criteria page on anthem.com
  • Post Service Clinical Coverage Reviews and Grievance and Appeals process and teams have not changed.

 

Here is a summary of the medical specialty drug changes, beginning June 15, 2019:

Action

Contact

Submit a new prior authorization request for medical specialty drug reviews

Call Anthem at 1-833-293-0659

OR

Fax us at 1-888-223-0550 for

OR

Access online at www.availity.com available 24/7  

Inquire about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration

Call Anthem at 1-833-293-0659



Featured In:
August 2019 Anthem Provider News - Ohio