BCBSMT Preauthorization Duties Changing from eviCore to AIM

Oct. 28, 2020

Effective Jan. 1, 2021, for some commercial plan members

What’s changing?
The utilization management vendor that processes preauthorizations for some of our commercial members is changing. Starting Jan. 1, 2021, preauthorization requests for commercial Blue Cross and Blue Shield of Montana (BCBSMT) members that are currently required to be submitted through eviCore healthcare will require preauthorization through AIM Specialty Health® (AIM).

What’s not changing?
The care categories that require preauthorization with AIM will stay the same:

  • Advanced imaging
  • Radiation therapy
  • Genetic testing

If benefit preauthorization is required, services performed without benefit preauthorization may be denied for payment and the rendering provider may not seek reimbursement from the member.

Learn more about preauthorization with BCBSMT on our website, including code lists for the services that require preauthorization. Remember code lists are updated periodically.

Always check eligibility and benefits first to confirm membership, coverage, determine if you are in-network for the member’s policy and whether preauthorization is required through our Availity® Learn more about third-party links system or your preferred vendor. This step will help you confirm coverage and other important details, such as preauthorization requirements and delegated vendors, if applicable.

How can you prepare?
Make sure you have an account with AIM. To create an account:

  • Online - Access AIM ProviderPortal Learn more about third-party links, or
  • By Phone – Call the AIM Contact Center at 800-859-5299 Monday through Friday, 7 a.m. to 7 p.m.

If you are already registered with AIM you do not need to register again.

How to submit a preauthorization request through AIM starting Jan. 1, 2021

Submit preauthorization requests to AIM in one of the following ways:

  • Online – Submit requests via the AIM ProviderPortal Learn more about third-party links 24/7.
  • By Phone – Call the AIM Contact Center at 844-377-1285 Monday through Friday, 7 a.m. to 7 p.m.

Why it matters
If benefit preauthorization is required, services performed without benefit preauthorization may be denied for payment and the rendering provider may not seek reimbursement from the member.

Which members and services need preauthorization?
Use Availity® or your preferred vendor to:

  • Check eligibility and benefits
  • Determine if you’re in-network for your patient
  • Find out if the patient and services require preauthorization
  • Learn whether preauthorization is required for a specific procedure code

Look for future news and updates on upcoming training and FAQs that will provide all the important information you need to successfully transition to AIM.

AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSMT.

Learn more about third-party links By clicking this link, you will go to a new website/app (“site”). This new site may be offered by a vendor or an independent third party. The site may also contain non-Medicare related information. In addition, some sites may require you to agree to their terms of use and privacy policy.

eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSMT.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT.

Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association