Aim Prior Authorization Process and Management

Prior authorization is a crucial step in the healthcare process, and understanding how it works is essential for patients, providers, and payers alike.

The prior authorization process typically involves submitting a request to the patient's insurance provider for approval before receiving a specific treatment or medication.

This process can be time-consuming and may require multiple submissions before approval is granted.

Insurance providers use a variety of criteria to determine whether to approve or deny a prior authorization request, including medical necessity, safety, and cost-effectiveness.

The goal of prior authorization is to ensure that patients receive the most effective and safe treatment possible, while also controlling healthcare costs.

A well-managed prior authorization process can help reduce administrative burdens and improve patient outcomes.

Suggestion: United Healthcare Prior Authorization Radiology

AIM Prior Authorization is a process designed to ensure patients receive necessary care while managing costs. It's used for certain outpatient services.

AIM works with leading insurers to improve health care quality and manage costs. This is achieved by promoting care that is appropriate, safe, and affordable.

A different take: Ambetter Absolute Total Care Prior Authorization Form

Prior authorization is required for certain outpatient services, which can be verified through Availity or your preferred vendor. This helps determine if a prior authorization is needed for the patient depending on their benefit plan.

The Prior Authorization process involves reviewing medical necessity for services. This helps ensure patients receive necessary care while managing costs.

Services that require prior authorization include outpatient high-tech diagnostic imaging services. These services are part of the Prenotification Radiology Quality Initiative (RQI) program.

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The AIM ProviderPortal offers several benefits that can streamline your prior authorization process. It provides self-service, smart clinical algorithms, and in many instances, real-time determinations.

With the AIM ProviderPortal, you can check prior authorization status at your convenience. This feature saves time and reduces administrative tasks.

One of the key advantages of the AIM ProviderPortal is that it increases payment certainty. This means you can have more confidence in getting paid for your services.

Here are some of the key features of the AIM ProviderPortal:

The digital age has transformed the way we handle prior auth, and it's now more efficient than ever. The completion of paperwork, including prior auth, happens increasingly online due to the shift away from in-office work.

With digital tools, the process is streamlined and faster. Dealing with prior auth online differs from the physical world.

The ease of online prior auth has made it a convenient option for many. The use of digital tools has made it possible to complete paperwork from anywhere, at any time.

Medical Specialty Care Benefits Management is a valuable feature that helps manage your medical expenses. It's offered through Carelon Medical Benefits Management, formerly known as AIM Specialty Health.

You can access the provider portal to submit a new case for prior authorization or check on an existing one. This is a convenient way to stay on top of your medical benefits.

Discover more: Prior Authorization Management

Carelon Medical Benefits Management uses evidence-based clinical guidelines and pathways in their review process. These guidelines are designed to ensure that medical decisions are based on the best available evidence.

By using these clinical guidelines, Carelon Medical Benefits Management can help ensure that you receive the most effective and efficient care possible.

The Radiology Quality Initiative is a program designed to ensure that high-tech diagnostic imaging services are used appropriately. AIM provides clinical appropriateness review and education for outpatient high-tech diagnostic imaging services through their prenotification Radiology Quality Initiative (RQI) program.

Specifically, this program applies to Blue Choice PPO members who require outpatient diagnostic imaging services such as CT/CTA, MRI/MRA, SPECT/Nuclear Cardiology studies, and PET scans. These services must be performed in a physician's/professional provider's office, the outpatient department of a hospital, or a freestanding imaging center.

Facilities can now obtain an RQI from AIM on behalf of the ordering physician. This is a convenient option for providers who want to streamline the process.

A unique perspective: Unitedhealthcare to Launch Prior Authorization Gold Card Program

The RQI program does not apply to Medicare primary members with BCBSTX Medicare supplement. It's essential to note that RQI requirements are for notification purposes only.

Here are the services that require an RQI number:

It's worth noting that failure to obtain an RQI number alone will not impact claims payment. However, if you do not obtain an RQI number before providing Advanced Imaging services and the services are subsequently deemed not medically necessary, claims payment will be impacted.

The AIM ProviderPortal offers a range of tools to streamline the prior authorization process. Self-service capabilities and smart clinical algorithms provide real-time determinations in many instances.

You can check the status of prior authorization requests right away, saving you time and effort. This feature is particularly useful for providers who need to manage multiple requests simultaneously.

The AIM ProviderPortal also increases payment certainty, which can be a significant advantage for providers who rely on timely reimbursement.

Here are some key features of the AIM ProviderPortal:

The Provider Portal for Reviews is a game-changer for healthcare providers.

One of the biggest benefits is that it offers self-service, smart clinical algorithms, and in many instances real-time determinations. This means you can quickly get the information you need to make informed decisions.

You can also check prior authorization status in real-time, which increases payment certainty and reduces the risk of denied claims.

Another advantage is that medical records for pre or post-service reviews are not necessary unless specifically requested by AIM. This streamlines the review process and saves you time.

Here are some key benefits of the Provider Portal for Reviews:

For Pharmacy Medical Oncology, things are changing on October 11, 2021. AIM Specialty Health will manage prior authorization requests and post-service medical necessity review for drugs in this care category.

Make sure you're registered with AIM before October 11, 2021, to avoid any issues. You can register online via the AIM Provider Portal or call the AIM Contact Center at 866-455-8415, Monday through Friday, 7 a.m. to 7 p.m., CT.

Prior authorization requests for Medical Oncology drug codes should not be submitted to BCBSIL for dates of service on or after October 11, 2021. Instead, submit them to AIM via their Provider Portal.

AIM's Provider Portal and call center will start accepting prior authorization requests on September 27, 2021, for dates of service on or after October 11, 2021.

Here are some key dates to keep in mind:

Remember to check eligibility and benefits first through the Availity Provider Portal or your preferred vendor portal to confirm prior authorization requirements and utilization management vendors, if applicable.

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Consider reading: Electronic Prior Authorization Vendors

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The AIM Prior Authorization Program is designed to streamline the process of getting approval for certain medical services. It's administered by AIM for select plans, including Blue Choice PPO, Blue Essentials, and Blue Premier Access.

The program covers a range of services, including cardiology, genetic testing, joint and spine surgery, medical oncology, radiation therapy, radiology, and sleep studies.

Here are some specific services that require prior authorization through AIM:

Before rendering services, providers need to determine if prior authorization is required through AIM. They can check with AIM to see if a prior authorization is needed, as services can vary depending on the patient's benefits.