Posted in Insurance, Updates

Empire BCBS New York Announcement- AIM Musculoskeletal Program to add more procedures to their Prior-Authorization list (Nov 1,2020)

Effective 11/01/2020- AIM Musculoskeletal Program will add certain lower extremity small joint surgeries. These surgeries will be subject to clinical appropriateness (medical necessity) and place of service (setting where the service will be performed-level of care review).

Surgeries that are included on this expanded list could be either elective or part of an inpatient admission.

The following non-emergency surgery list* applies:

1. Total joint replacement of ankle

2.Correction of Hallux Valgus

3.Hammertoe Repair

* Includes all associated revision surgeries.

Plan Members that are included in this new program:

1. ASO members that currently participate in the AIM Musculoskeletal Program

2. Members that are part of ASO group that do not participate with the AIM Musculoskeletal Program- ASO groups will have an option to add AIM to benefits packages of their members as of 11/01/2020

Time Frame: For any surgeries that will be done on 11/01/2020 and thereafter, AIM will start to accept prior auth requests on 10/26/20.

How to request an authorization:

1. Online: provider portal aimspecialtyhealth.com/goweb – providers will need to register in order to use this option. Fast and  convenient.

2. Phone: Call AIM Specialty Health at 1-877-430-2288, M-F 8:30am to 7:00pm.

For the complete list of AIM surgery guidelines and level of care guidelines, please click here https://aimspecialtyhealth.com/resources/clinical-guidelines/musculoskeletal/

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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