Nov 1, 2022 • Administrative

Providers currently submit prior authorization (PA) requests to AIM Specialty Health®* (AIM) for outpatient diagnostic imaging services. These PA requests are often reviewed based on provider attestation of certain requirements.

 

As part of our ongoing quality improvement efforts, we want you to know that some review requests may require documentation to substantiate the attestations that support the clinical appropriateness of the request. This documentation can be uploaded during the intake process.

 

When requested, providers must submit such documentation from the patient’s medical record. If medical necessity is not supported through documents submitted, the request may be denied as not medically necessary. Such documentation is limited to what has been asserted via the PA review attestations.

 

If the PA request results in a denial as not medically necessary, providers may participate in a peer-to-peer discussion with an AIM physician reviewer and/or submit such documentation for a re-review within the allotted timeframes.

 

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Empire BlueCross BlueShield.

 

NYBCBS-CM-009685-22


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November 2022 Newsletter