Federal Employee Program® AIM radiology prior authorization review
Effective with dates of service on or after October 1, 2021, Anthem Blue Cross and Blue Shield Federal Employee Program (FEP) will transition all review of diagnostic imaging services to AIM Specialty Health® (AIM). These services will require prior authorization to determine medical necessity prior to rendering the service for Anthem federal employee members.
Your practice can benefit from participation in several ways, including:
- Improving the clinical appropriateness of imaging services through the application of evidence-based guidelines in an efficient and effective review process. Anthem Federal Employee Program (FEP) will be utilizing the FEP medical policy to review for medical necessity. In the absence of a controlling FEP Medical Policy, medical necessity determinations will be made using Anthem coverage guidelines, and/or AIM clinical guidelines.
- Maximizing a health plan’s network value through a wide range of solutions including provider assessment tools, cost and quality transparency and reporting.
- Engaging consumers in understanding the range of choices they have in selecting imaging providers and increasing their ability to make informed decisions.
For services that are scheduled to begin on or after October 1, 2021, all providers must contact AIM to obtain pre-service review for the following non-emergency modalities:
- Nuclear imaging, including myocardial perfusion imaging, cardiac blood pool imaging, infarct imaging and Positron Emission Tomography (PET) myocardial imaging
- Computed Tomography (CT), including CT angiography, derived fractional flow reserve, structural CT and quantitative evaluation of coronary calcification
- Magnetic Resonance Imaging (MRI)
- Magnetic Resonance Angiography (MRA)
- Magnetic Resonance Spectroscopy (MRS)
- Functional MRI (fMRI)
- Stress Echocardiography (SE)*
- Resting Echocardiography (TTE)*
- Transesophageal Echocardiography (TEE)*
How to submit a request for review
Starting September 20, 2021, providers can begin submitting requests for review with dates of service on or after October 1, 2021, or can verify order numbers using one of the following methods as a registered AIM portal provider:
How to register online
The AIM ProviderPortalSM is available 24/7, fully interactive, and processes requests in real-time using clinical criteria. To register, go to https://aimspecialtyhealth.com/providerportal/. Registration opens September 20, 2021.
How to register by phone
Call AIM Specialty Health toll-free at 866-789-0397, Monday through Friday between 7 a.m. to 7 p.m. CT.
For more information about the radiology program and to help your practice get started, go to: http://www.aimprovider.com/radiology.This website can also help you learn more about provider access to useful information and tools such as order entry checklists and clinical guidelines.
Anthem Federal Employee Program values your participation in our network, as well as the services you provide. We look forward to working with you to help improve the health of our members.
July 2021 Anthem Provider News - Virginia