June 26, 2020
What you need to know: On Sept. 1, 2020, we will be using AIM Specialty Health to process prior authorization and post review support for some members on our Blue Choice PPOSM and Blue EssentialsSM networks.
You will be able to identify the impacted members by the three-character prefixes: (T2U and T2S) on the member's ID card.
Dig deeper: Currently, AIM handles a prenotification Radiology Quality Initiative Program for our Blue Choice PPO plans and has a high satisfaction rating with providers. The new agreement expands AIM's capabilities by providing required prior authorization review and approvals for select outpatient services for some members using the Blue Choice PPO and Blue Essentials networks.
Select outpatient procedures that may require prior authorization through AIM include:
- Advanced Imaging
- Sleep Medicine
- Pain Management
- Joint and Spine Surgery
- Radiation Therapy
- Genetic Testing
We'll share more information about prior authorization requirements with AIM as we get closer to Sept. 1. Additionally, please check News and Updates and our Blue Review newsletter for training opportunities with AIM and updated details.
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on Blue Cross and Blue Shield of Texas (BCBSTX's) provider website.
Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been prior authorized or predetermined for benefits 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 applicable on the date services were rendered. If you have questions, contact the number on the member's ID card
AIM Specialty Health is an independent medical benefits management company that provides utilization management services for Blue Cross and Blue Shield of Texas (BCBSTX).
The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.