Posted in BCBS Empire NY, NY Providers, Training, Updates

Empire BCBS (NY) Changes to AIM Small Joint Surgery Guideline for 2021

Reminder: as of 11/01/2020 IM Specialty Health® (AIM) began administering the AIM Musculoskeletal program to perform medical necessity reviews for certain elective surgeries of the small joints using AIM clinical guidelines for Empire BlueCross BlueShield (“Empire”) fully insured members and some ASO groups.   

Effective 03/14/2021, the following changes will be made to the Small Joint Surgery Guidelines:

  • Clarified requirements for imaging reports.
  • Removed radiographic requirement for confirmation of lesser toe deformities.
  • Ankle arthrodesis and total ankle arthroplasty added as new indications for revision of failed previous reconstructions.
  • Removed total ankle arthroplasty requirements for adjacent joint or inflammatory arthritis.
  • Clarified contraindications only apply to total ankle arthroplasty.

How to request an authorization:

  • Access AIM ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
  • Access AIM via the Availity Portal at availity.com
  • Call the AIM toll-free number at 1-877-430-2288, Monday through Friday 8:30 am – 7 pm ET.

For further questions, please contact the provider number on the back of the member ID card.

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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