New precertification requirement for EGD services begins January 1, 2019
Beginning with dates of service on and after January 1, 2019, Anthem Blue Cross and Blue Shield will expand precertification requirements to include upper gastrointestinal (GI) endoscopy, also referred to as esophagogastroduodenoscopy (EGD). AIM Specialty Health® (AIM), a separate company, will administer this EGD review on behalf of Anthem.
EGD procedures will be reviewed against clinical guideline CG-MED-59, Upper Gastrointestinal Endoscopy, for clinical appropriateness and to help ensure care aligns with established evidence-based medicine. Please note, procedures performed in an inpatient or observation setting, or on an emergent basis will not be reviewed under CG-MED-59.
A complete list of EGD CPT codes requiring precertification is available on the www.aimproviders.com/surgicalprocedures
Submit a request for review
Starting December 19, 2018, ordering providers may submit precertification requests for dates of service on or after January 1, 2019, to AIM in one of the following ways:
- Access AIM 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 number: 866-789-0158, Monday – Friday, 8 a.m. to 5 p.m. ET.
Please note, this review does not apply to the following plans: BlueCard®, Federal Employee Program® (FEP®), Medicaid, Medicare Advantage, Medicare Supplemental plans.
Providers can view precertification requirements for Anthem members at Coverage & Clinical UM Guidelines, and Pre-Cert Requirements at the Virginia provider section of anthem.com. Providers should continue to verify eligibility and benefits for all members prior to rendering services.
For questions, please contact the Provider Service number on the back of the member ID card.
October 2018 Anthem Provider Newsletter - Virginia