AIM to ask for clinical information for BCN commercial radiology and cardiology prior authorization requests starting Jan. 1

Starting Jan. 1, 2022, AIM Specialty Health^® may ask for clinical information for prior authorization requests submitted for Blue Care Network commercial members for the following services:

• All outpatient high-technology radiology procedures
• Some outpatient cardiology procedures — specifically, diagnostic cardiac angiography and percutaneous coronary intervention

AIM may request the additional information as part of the prior authorization process. You'll need to submit documentation from the member's medical record that verifies the member's condition.

AIM will review the clinical information and use it in determining the clinical appropriateness of the request. AIM is initiating this as part of their ongoing quality improvement efforts.

If the information you provide does not support the medical necessity of the request, AIM may deny the request.

This won't apply to prior authorization requests submitted for Blue Cross commercial, Medicare Plus Blue^SM or BCN Advantage^SM members.

AIM is an independent company that manages authorization requests for high-technology radiology and other services for many Blue Cross and BCN members.

You can find information about AIM's requirements related to services for BCN members on our ereferrals.bcbsm.com website, on the BCN AIM-Managed Procedures webpage.

Posted: October 2021
Line of business: Blue Care Network