“AIM was founded on a commitment to provider service and clinical engagement. “We selected it because of AIM’s culture of innovation, ease of use, and responsiveness to the provider community.” “We have always appreciated AIM’s focus on automation and high touch clinical engagement, and with AIM Inform, we will gain enhancements to our pre-authorization workflow and save staff time,” said Brad Buxton, vice president of strategy and business development at Northwest Community Hospital. The product has satisfied the requirements to be included within the Epic App Orchard, which facilitates the integration into the EPIC EMR system. Today, AIM Inform includes prior authorization programs for outpatient high-tech, diagnostic imaging services, and there are plans to expand to other AIM-managed clinical areas such as oncology, musculoskeletal, and genetic testing in future releases. The product facilitates provider access to prior authorization programs operated by AIM for its health plan clients in all 50 states. AIM Inform, a solution from AIM Specialty Health, integrates with EMR systems to streamline a provider’s workflow, whether to comply with a health plan’s prior authorization requirements or to meet CMS criteria. Healthcare providers can now save time and administrative costs by integrating their EMR with AIM Inform to complete prior authorizations for high-tech, diagnostic imaging services and comply with the Centers for Medicare and Medicaid Services 2020 mandate to use Appropriate Use Criteria. Carelon resources for providersĬarelon Medical Benefits Management is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers.Healthcare providers save time and costs with new integrated product from AIM Specialty HealthĪIM Inform helps providers meet 2020 CMS guidelines for Medicare patients If you have questions, call Carelon at 86. In addition, servicing providers must submit ordering/referring provider information, per guidelines from theĬenters for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. Prior authorization isn't required for the following: To request a prior authorization, register with Carelon and then submit your request online or by phone at 86. Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)Ĭode list to see which codes require review.Ĭarelon Clinical Appropriateness Guidelines.The following services are subject to review by Carelon: It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. Prior authorization is based on member benefits and eligibility at the time of service. Providers must make prior authorization requests through Carelon for members on plans that require it. Prior authorization is required for certain procedures and services.Ĭontracted providers are financially liable for providing services that are medically unnecessary. Medical Benefits Management (formerly AIM) manages prior authorization for select services for Premera Blue Cross. AIM Specialty Health is officially changing its name to Carelon Medical Benefits Management on March 1, 2023.
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