Federal Employee Program® AIM Radiology prior authorization review transition delayed until November 1
In the July 2021 edition of Provider News, Anthem Blue Cross and Blue Shield (Anthem) announced that the Blue Cross and Blue Shield Service Benefit Plan (also called Federal Employee Program or FEP) will transition all reviews of diagnostic imaging services to AIM Specialty Health® (AIM) beginning October 1. 2021. In this September edition, we are sharing that the effective date of this transition has changed to November 1, 2021. 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’s 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 November 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
In the July 2021 edition of Provider News, we also announced that providers could begin submitting requests for review on September 20, 2021. This date has now changed. Starting October 18, 2021, providers can begin submitting requests for review with dates of service on or after November 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/.
How to register by phone:
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’s 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.
September 2021 Anthem Provider News - Virginia