Prior authorization is required for certain procedures and services. Contracted providers are financially liable for providing services that are medically unnecessary.
Prior authorization is based on member benefits and eligibility at the time of service. It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines.
AIM Specialty Health (AIM) manages imaging services for Premera Blue Cross. Providers must make pre-approval requests through AIM for members on plans that require it.
The following services are subject to review:
- CT scan
- MRI/MRA
- Nuclear Cardiology
- Echocardiography (ECHO)
- PET scan
View the
2016 AIM CPT Code List to see which codes require review, or log in to use our
prior authorization tool.
View
AIM Clinical Appropriateness Guidelines (updated twice yearly).
To request an order number, register with AIM and then submit your request online or by phone:
An order number isn't required for the following:
- Emergency room services
- Inpatient hospitalization
- Outpatient surgeries (hospitals and freestanding surgery centers)
- 23-hour observations
Diagnostic imaging services providers are strongly encouraged to verify that the pre-approval has been received before scheduling and performing diagnostic imaging exams. In addition, imaging providers must submit ordering/referring provider information, per guidelines from the Centers for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms.
If you have questions, please call AIM at 866-666-0776.
AIM Resources for Providers
AIM Reference Info and Checklist
AIM Clinical Information Checklist
AIM Order Entry Tip Sheet
AIM Specialty Health is an independent company providing advanced imaging services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers.