![]() ![]() ![]() If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM Specialty Health. If you have any questions, please call the number on the member’s ID card.ĪIM Specialty Health is an independent medical benefits management company that provides utilization management services for BCBSNM. ![]() 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. Refer to the Eligibility and Benefits User Guide for assistance with determining prior authorization requirements in the Availity portal.Ĭhecking eligibility and/or benefit information is not a guarantee of payment. The process of submitting prior authorization requests to Blue Cross and Blue Shield of New Mexico (BCBSNM) or through other vendors has not changed. *The above information applies only to prior authorization requests handled by AIM. Users will be redirected to the AIM portal to start and submit the prior authorization request.Select your provider organization and provider type (provider or facility), then click Submit.On the Authorization page, select the AIM (BCBSNM) link in the Additional Authorizations and Referrals section.Select Patient Registration from the navigation menu and choose Authorizations & Referrals.How to Access AIM from the Availity Portal* If the requested service(s) require prior authorization through AIM Specialty Health, providers can now utilize the new single sign-on access to AIM from the Availity portal. The Availity Eligibility and Benefits Inquiry allows you to quickly confirm prior authorization requirements, along with contact information for the utilization management vendor, if applicable. Availity provides administrative services to BCBSTX.Checking patient eligibility and benefits is an imperative first step to confirm coverage and prior authorization requirements before rendering services. If you have any questions, you may contact your Network Management Representative.ĪIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX.Īvaility is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Look for future news and updates on upcoming training and FAQs that will provide all of the important information you need regarding AIM. If benefit prior authorization is required, services performed without benefit prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member. You can appeal a denied prior authorization request for an advanced imaging study prior to service by contacting Carelon directly at 86. By Phone – Call the AIM Contact Center at 1-80 Monday through Friday, 6 a.m.Online – Submit requests via the AIM ProviderPortal 24/7.Submit prior authorization requests to AIM. If you are already registered with AIM, you do not need to register again. By Phone – Call the AIM Contact Center at 1-80 Monday through Friday, 6 a.m.Learn whether prior authorization is required for a procedure code and who to contact.Find out if the patient and services require prior authorization or a RQI prenotification.Determine if you’re in-network for your patient.Use Availity ®or your preferred vendor or call the number on the back of the ID card to: You can find code lists for the services that require prior authorization on our provider website.Ĭheck which members and services need prior authorization **The AIM Radiology Quality Initiative program (RQI) for Blue Choice PPO members will continue for members that do not require an advanced imaging prior authorization. * Exception are updates for new, replaced or removed procedure codes that may occur to comply with American Medical Association or Centers for Medicare & Medicaid Services or other industry-standard entities. The care categories and procedure codes that currently require prior authorization will stay the same* as the previous vendor: (Note: There are no changes to the vendors for BCBSTX Government Programs (Medicare Advantage and Medicaid plans). Blue High Performance Network SM (New plan effective Jan.Blue Premier SM and Blue Premier Access SM.Blue Essentials SM and Blue Essentials Access SM.The utilization management vendor that manages certain outpatient prior authorizations for some members in the plans listed below will be AIM Specialty Health ® (AIM) effective Jan. ![]()
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