Reminder: Use AIM for Prior Authorization - Coming for Pharmacy Medical Oncology

September 3, 2021
 

Remember What’s Changing: Blue Cross and Blue Shield of New Mexico (BCBSNM) is changing prior authorization requirements that may apply to some commercial and Blue Cross Community CentennialSM members.

Starting October 11, 2021, AIM Specialty Health® (AIM), rather than BCBSNM, will manage prior authorization requests and post service medical necessity reviews for drugs in the Pharmacy Medical Oncology care category for some members.

Tips for using the AIM ProviderPortal for Pre & Post-Service Reviews

  • Do not submit medical records to BCBSNM for care categories managed by AIM
  • If medical records are needed, AIM will request them via the ProviderPortal
  • Use the AIM ProviderPortal to request prior authorization (pre-service)
  • Post-service review requests should also be submitted directly to AIM via the ProviderPortal
  • Check prior authorization status on the AIM 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

Join Us for A Webinar to Learn More: It’s important to 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. Visit the AIM microsite for links to future training dates or register at these links below.


AIM Medical Oncology Training Dates and Times
Wednesday, September 15, 2021 from 2 – 3 p.m. CST Register
Friday, September 24, 2021 from 9 – 10 a.m. CST Register
Tuesday, September 28, 2021 from noon – 1 p.m. CST Register
Wednesday, October 6, 2021 from noon – 1 p.m. CST Register
Tuesday, October 12, 2021 from noon – 1 p.m. CST Register

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 BCBSNM.

More Information: Refer to this previous News and Updates article . The updated Specialty Drug Code list includes the drugs for Medical Oncology that AIM will review starting October 11, 2021. The Specialty Drug Code List is posted here.

Find information about our prior authorization program with AIM at this microsite .

Other Important Reminders: 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 844-377-1285, Monday through Friday, 7 a.m. to 7 p.m., MT.

For More Information: Continue to watch the News and Updates for reminders, announcements and educational resources that will help you transition to submitting prior authorization requests through AIM.

Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, 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 BCBSNM to provide utilization management services for members with coverage through BCBSNM. 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 BCBSNM. BCBSNM 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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