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 needed for an Anthem member, please call the prior authorization phone 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 packages as of November 1, 2020.

 

Prior authorization requirements

 

For surgeries that are 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. 

 

How to place a review request:


Online

 

Get fast, convenient online service via the AIM ProviderPortalSMProviderPortal is available 24 hours a day, seven days a week, processing requests in real-time using clinical criteria.  Go to www.aimspecialtyhealth.com/goweb to register. 

 

By phone

 

Call AIM Specialty Health toll-free at (866) 789-0158, Monday through Friday, 8:30 a.m. – 7 p.m. ET. 

 

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 special website helps you learn more and access 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.

 

* A specialty health benefits company, AIM works with leading insurers to improve health care quality and manage costs for today’s most complex and prevalent tests and treatments, helping to promote care that is appropriate, safe and affordable. 

 

571-0820-PN-VA



Featured In:
August 2020 Anthem Provider News - Virginia