Providers must obtain authorization from AIM Specialty Health® for:
- Select cardiology and radiology services with dates of service on or after Oct. 1, 2018, for BCN HMOSM and BCN AdvantageSM members. This includes cardiac implantable devices and services, for dates of service on or after Jan. 1, 2021.
- Medical oncology and supportive care drugs for BCN HMO members (effective Aug. 1, 2019) and for BCN Advantage members (effective Jan. 1, 2020)
The cardiology and radiology services requirement applies to services performed in the following settings:
- Freestanding diagnostic facilities
- Outpatient hospital settings
- Ambulatory surgery centers
- Physician offices
When cardiology and radiology services are performed in an observation, emergency or inpatient care setting, they do not require authorization.
More information on the medical oncology and supportive care drugs requirement is available in the May-June 2019 issue of BCN Provider News on page 26.
How to submit authorization requests
Submit authorization requests using one of the following methods:
- Use the AIM provider portal*
- Call AIM at 1-844-377-1278
Requests should be submitted before the services are provided.
Refer to the resources below for more information:
- Medical oncology and supportive care drugs that require authorization by AIM Specialty Health (PDF) - A list of drugs and codes that require authorization through AIM for BCN HMO members (beginning Aug. 1, 2019) and for Blue Cross' PPO fully insured members (beginning Dec. 1, 2020)
- Medical oncology and supportive care drugs that require authorization by AIM for Medicare Advantage members effective Jan. 1, 2020 (PDF) - A list of drugs and codes that require prior authorization, including those managed by AIM Specialty Health effective Jan. 1, 2020, for BCN AdvantageSM and Medicare Plus BlueSM PPO members
- AIM Oncology Management Program resources* - An AIM website providing Cancer Treatment Pathways worksheets, prior authorization requirements and other resources that help providers compare planned cancer treatment regimens against evidence-based regimens that align with BCN and Blue Cross medical policy.
- Cardiology and radiology procedures that require authorization by AIM Specialty Health (PDF) - A list of codes representing the cardiology and radiology procedures AIM manages for dates of service on or after Oct. 1, 2018, for BCN HMO and BCN Advantage members. This includes cardiac implantable devices and services, for dates of service on or after Jan. 1, 2021.
- Frequently asked questions
- Frequently asked questions about AIM (PDF) - Answers to some general questions about working with AIM on select cardiology and radiology services for BCN
- Frequently asked questions about AIM's ProviderPortalSM * - Additional questions and answers about working with AIM from the AIM website
- Oncology management program: Frequently asked questions for providers (PDF) - Questions and answers about the oncology management program for BCN HMO (commercial) members (effective Aug. 1, 2019) and BCN Advantage members (effective Jan. 1, 2020)
Click the image to learn about the scope of the AIM authorization program, how to submit authorization requests and how to appeal decisions.
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