October 2021
Reminder: Prior Authorization Vendor Change for Pharmacy Medical Oncology – Join Us for A Webinar
What’s Changing: Blue Cross and Blue Shield of Illinois (BCBSIL) is changing prior authorization requirements that may apply to some commercial, non-HMO members.
As we announced on July 7, 2021, starting Oct. 11, 2021, AIM Specialty Health® (AIM), rather than BCBSIL, will manage prior authorization requests and post-service medical necessity reviews for drugs in the Pharmacy Medical Oncology care category for some BCBSIL members. (Remember: Always check eligibility and benefits first via the Availity® Provider Portal or your preferred vendor before rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.)
Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested isn’t associated with an oncology diagnosis, it will be reviewed by BCBSIL.
To prepare for this change, make sure you’re registered with AIM, prior to Oct. 11, 2021. If you’re already registered with AIM to submit Radiology Quality Initiative (RQI) requests for BCBSIL members, you don’t need to register again. 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 - Friday, 7 a.m. to 7 p.m., CT
For more reminders, key dates and scenarios as we transition to AIM, please refer to the previous announcement. We’ve also listed some quick tips on using the AIM ProviderPortal for pre- and post-service review below. For more in-depth training, be sure to sign up for a webinar.
Tips for Using the AIM ProviderPortal
- Don’t submit medical records to BCBSIL for care categories managed by AIM
- If medical records are needed, AIM will request them via the AIM 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
- 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
Provider Training
AIM is hosting free webinars on how to use the AIM ProviderPortal to enter medical oncology prior authorization requests. To register, select your preferred date and time from the list below:
This program does not apply to government programs or any of our HMO members.
- Oct. 6, 2021 – noon to 1 p.m., CT
- Oct. 12, 2021 – noon to 1 p.m., CT
- Oct. 28, 2021 – 9 to 10 a.m., CT
- Nov. 2, 2021 – 2 to 3 p.m., CT
Also join our BCBSIL Provider Network Consultant team for a 2021 Commercial Prior Authorization Reminders and Updates training. You’ll get an overview of prior authorization and related requests for review – including how to check eligibility and benefits – with an emphasis on helping you prepare for the AIM Pharmacy Medical Oncology transition, effective Oct. 11, 2021. Register today by selecting your preferred session below: |
For More Information
Refer to the Utilization Management section of our Provider website for an updated 2021 Commercial Specialty Pharmacy Prior Authorization Drug List. This list is posted on the Support Materials (Commercial) page. It includes the drugs for Medical Oncology that AIM will review starting Oct. 11, 2021. Also refer to the Resources page on AIM’s website for clinical guidelines, frequently asked questions and more.
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 BCBSIL to provide utilization management services for members with coverage through BCBSIL. 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 BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM or Availity.