This step will help you confirm coverage and other important details, such as prior authorization requirements and vendors, if applicable. Always check eligibility and benefits first, through the Availity ® Provider Portal or your preferred web vendor, prior to rendering services. Member benefits will vary based on the service being rendered and individual and group policy elections. By Phone – Call the AIM Contact Center at 86, Monday through Friday, 7 a.m.Online – Go to the AIM ProviderPortal or.Make sure you’re registered with AIM prior to Jan. Select your preferred date and time from the list below to sign up now: Please attend an online training session for more in-depth information on key dates, as well as a preview of the AIM ProviderPortal and BCBSIL-specific resources on the AIM website. Do not submit prior authorization requests to eviCore for dates of service on or after Jan. 1, 2021, commercial prior authorization requests must be submitted to AIM. 21, 2020, for dates of service on or after Jan. AIM’s ProviderPortal will be open for you to begin submitting prior authorization requests effective Dec.31, 2020, for dates of service before or on Dec. Continue to submit prior authorization requests to eviCore through Dec.The update below includes: Key dates to consider as we transition care for some members between eviCore and AIM new contact information for AIM and hours of operation and reminders on upcoming training dates.Ĭonsider these key dates and scenarios during the transition of care between eviCore and AIM: 1, 2021, prior authorization requests for commercial Blue Cross and Blue Shield of Illinois (BCBSIL) members that are currently required to be submitted through eviCore healthcare (eviCore) will require prior authorization through AIM Specialty Health ® (AIM). 1, 2020, we alerted you that the utilization management vendor that processes prior authorizations for some of our commercial members is changing. 5 p.m.December 2020 Transition of Member Care: Commercial Prior Authorization Change from eviCore to AIM By phone: Blue Cross NC Utilization Management at 1-80 Monday to Friday, 8 a.m.Your health care provider can use any of the following ways to request prior review and certification: How can my provider request prior review and certification? Certain durable medical equipment (DME).Air ambulance services (emergency air ambulance does not require prior review).Services performed by an out-of-network or non-BlueCard® out-of-state health care provider.Private duty nursing, skilled nursing facility, acute rehabilitation admissions (short-term inpatient recovery), home health care (including nursing and some home infusion).Inpatient maternity stays longer than 48 hours after vaginal delivery or 96 hours after a C-section.Inpatient admissions (with the exception of maternity admissions) - elective, planned in advance or not related to an emergency.The following procedures typically require prior review and certification:, Always check your Benefit Booklet for specific information about your plan. Whether prior review and certification is required may depend on your Blue Cross NC benefit plan. What types of procedures may require prior review and certification? Note: Blue Cross NC may certify a service received out-of-network at the in-network benefit level if the service is not reasonably available in-network or if there is a continuity of care issue. Special medical circumstances are identified that require specific types of review and follow-up.The provider is correctly identified as in- or out-of-network.The service is performed in the right health care setting.The service is medically necessary according to Blue Cross NC medical policy.Your benefits cover the service in question.Prior review and certification ensures that: Prior Review and Certification Code List Why is prior review and certification necessary? If there is no update within this time period, the list will remain unchanged until the following quarter. It is a provider tool and is updated on a quarterly basis, within the first 10 days of January, April, July, and October. This list is provided for member information only. Prior review and Certification Code list: Blue Cross NC should be notified of an urgent or emergency admission by the second business day of the admission. In case of emergency, prior review and certification is NOT required. Prior review and certification is also known as: Non-Discrimination Policy and Accessibility Services.Get a Quote for Individual and Family PlansĪncillary and Specialty Benefits for Employees.Health Plans for Individuals and Families.
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