Prior Authorization Update - Medical Oncology
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.
- 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.
- 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.
Key Dates and Scenarios for the Transition to Medical Oncology to AIM:
- For Dates of Service prior to Oct. 11, 2021
- Continue to submit prior authorization requests to BCBSTX Medical Management through Oct. 10, 2021.
- Contact BCBSTX to extend an active authorization for dates of service prior to Oct. 11, 2021.
- Authorizations initiated with BCBSTX will remain active with BCBSTX until the request expires, including dates before or after Oct. 11, 2021.
- For Dates of Services Oct. 11, 2021 and after:
- Utilize the AIM ProviderPortal to extend an active authorization
- Contact AIM to initiate new authorizations. Please use the AIM ProviderPortal for these new requests.
- AIM’s ProviderPortal and call center will be begin accepting prior authorization requests on Sep. 27, 2021 for dates of service on or after October 11, 2021.
- Do not submit prior authorization requests for Medical Oncology drug codes to BCBSTX Medical Management
- Predetermination of Benefits will no longer be offered for the Medical Oncology care category. All requests will be processed as a prior authorization.
Codes have been updated on the Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans located on the Utilization Management page of the provider website. Watch for updates on the AIM microsite for Medical Oncology information. Continue to watch News and Updates for reminders, announcements and educational resources including AIM Medical Oncology training webinars.
Make sure you’re registered with AIM, prior to Oct. 11, 2021. [If you’re already registered with AIM, you don’t need to register again.] There are two ways to register:
- Online – Go to the AIM ProviderPortal ; or
- By Phone – Call the AIM Contact Center at 1-866-859-5299, Monday through Friday, 7 a.m. to 7 p.m., CT.
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.
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