Reminder: Medical Oncology Prior Authorization Update
Reminder: Starting Oct. 11, 2021, AIM Specialty Health® (AIM), will begin managing prior authorization and post service medical necessity review requests for drugs for the "Medical Oncology" care category for certain Blue Cross and Blue Shield of Texas (BCBSTX) commercial members. In some cases, AIM is managing the drug in place of BCBSTX Medical Management.
Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested is not associated with an oncology diagnosis, it will be reviewed by BCBSTX.
Tips for using the AIM ProviderPortal for Pre & Post-Service Reviews
- If medical records are needed, AIM will request them via the ProviderPortal
- Do not submit medical records to BCBSTX for care categories managed by AIM
- Use the AIM ProviderPortal to request prior authorization (pre-service) and check prior authorization status
- Post-service review requests should also be submitted directly to AIM via the ProviderPortal
AIM’s ProviderPortal Offers End-to-End Efficiencies for pre- and post-service reviews
- Self-service available 24/7 - Check order status and view order history
- Faster pre-service decision turnaround times than post service reviews
- Smart clinical algorithms mean real-time determinations, in many cases - Increases payment certainty
- Transparent feedback before transferring to clinical review
Make sure you’re registered with AIM, prior to October 11, 2021. There are two ways to register:
- Online – Go to the AIM ProviderPortal ; or
- By Phone – Call the AIM Contact Center at 1-844-377-1285, Monday through Friday, 7 a.m. to 7 p.m., CT.
Attend an online training session for more in-depth information. You can also get a preview of the AIM ProviderPortal and the Medical Oncology program. Register for upcoming sessions on the AIM microsite or refer to Training for Pharmacy Medical Oncology Through AIM.
- Refer to the previous announcement article for key transition dates
- Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans under the Utilization Management page includes Procedure Codes Lists with the drugs for Medical Oncology that AIM will review.
- AIM microsite
- Check our News and Updates page
Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSTX to provide utilization management services for members with coverage through BCBSTX.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.