AIM Specialty Health (AIM) manages prior authorization for select services for Premera Blue Cross. Prior authorization is required for certain procedures and services.
Contracted providers are financially liable for providing services that are medically unnecessary. Providers must make prior authorization requests through AIM for members on plans that require it.
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.
The following services are subject to review by AIM:
- Genetic testing
- Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)
- Radiation oncology
- Sleep study
View the
code list to see which codes require review.
View
AIM Clinical Appropriateness Guidelines.
To request a prior authorization, register with AIM and then submit your request online or by phone at 866-666-0776.
Prior authorization isn't required for the following:
- Emergency room services
- Inpatient hospitalization
- 23-hour observations
Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. In addition, servicing 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, call AIM at 866-666-0776.
AIM Resources for Providers
AIM Specialty Health is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers.