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:
- CT scan
- MRI, MRA
- Nuclear cardiology
- Echocardiography (ECHO)
- PET scan
- Sleep study
- Radiation oncology
- Genetic testing: Available through AIM for dates of service beginning January 4, 2019. Learn more about genetic testing through AIM
and read the Provider News
article.
View the
code list to see which codes require review, or sign 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
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 clinical information checklist
AIM order entry tip sheet
Sleep study program
Genetic testing program
AIM Specialty Health is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers.