Oct. 19, 2021
What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements for specialty drugs used for oncologic application.
Starting October 11, 2021, AIM Specialty Health® (AIM), rather than BCBSMT, will manage prior authorization requests and post service medical necessity reviews for drugs in the Pharmacy Medical Oncology care category for some members.
Tips for using the AIM ProviderPortal for Pre & Post-Service Reviews
- Do not submit medical records to BCBSMT for care categories managed by AIM
- If medical records are needed, AIM will request them via the ProviderPortal
- Use the AIM ProviderPortal to request prior authorization (pre-service)
- Post-service review requests should also be submitted directly to AIM via the ProviderPortal
- Check prior authorization status on the AIM ProviderPortal
AIM’s ProviderPortal Offers End-to-End Efficiencies for pre- and post-service reviews
- Self-service available 24/7 • Check order status and view order history
- Faster pre-service decision turnaround times than post service reviews
- Smart clinical algorithms mean real-time determinations, in many cases • Increases payment certainty
- Transparent feedback before transferring to clinical review
Join Us for A Webinar to Learn More: It’s important to attend an online training session for more in-depth information. You can also get a preview of the AIM ProviderPortal and the Medical Oncology program. Visit the AIM microsite for links to future training dates or register at these links below.
|AIM Medical Oncology Training Dates and Times|
|Wednesday, September 15, 2021 from 1p.m. – 2 p.m. MST||Register|
|Friday, September 24, 2021 from 8 a.m.– 9 a.m. MST||Register|
|Tuesday, September 28, 2021 from 11a.m. – Noon MST||Register|
|Wednesday, October 6, 2021 from 11 a.m. – Noon MST||Register|
|Tuesday, October 12, 2021 from 11 a.m. – Noon MST||Register|
What’s Not Changing: Healthy Montana Kids (HMK) medical drug applications will continue to be managed by BCBSMT.
Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested is not associated with an oncology diagnosis, it will be reviewed by BCBSMT.
More Information: Refer to this previous News and Updates article and the Utilization Management section of our Provider website. The updated Specialty Drug Code list includes the drugs for Medical Oncology that AIM will review starting October 11, 2021. The Speciality Drug Code List is posted here .
Find information about our prior authorization program with AIM at this microsite .
Other Important Reminders: Make sure you’re registered with AIM, prior to October 11, 2021.
There are two ways to register:
- Online – Go to the AIM ProviderPortal; or
- By Phone – Call the AIM Contact Center at 844-377-1285, Monday through Friday, 7 a.m. to 7 p.m., MT.
Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.
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