AIM Specialty Health
We use an independent company, AIM Specialty Health, to develop or consult on clinical criteria for the following services. AIM also conducts the medical necessity review for these services. To request prior authorization with AIM, contact them directly https://www.providerportal.com/.
- Radiology Imaging Management 968 and CPT and HCPCS Codes 900
- Sleep Disorder Management 969 and CPT and HCPCS Codes 970
- Genetic Testing Management 954 and CPT and HCPCS Codes 957
AIM Specialty Health, an independent company, conducts utilization management as the delegated vendor for Advanced Imaging/Radiology, Sleep Disorder Management and Genetic Testing.
The AIM Specialty Health Program is our delegated utilization management vendor for the following medical policy categories: Advanced Imaging/Radiology; Advanced Imaging of the Heart; Sleep Disorder Management; and Genetic Testing. Blue Cross Blue Shield of Massachusetts medical policies in these categories are aligned with AIM guidelines.
AIM Specialty Health draft guidelines are routinely sent to the Blue Cross Blue Shield of Massachusetts Senior Director of Medical Policy and the Senior Director of Clinical Pharmacy for review before they are finalized. They are reviewed to ensure that the most up-to-date clinical indications are included. Feedback from providers regarding local clinical practice trends are also shared with AIM by the Blue Cross Blue Shield of Massachusetts Senior Director.
AIM guidelines are reviewed at least annually. The finalized updates are sent to Blue Cross Blue Shield of Massachusetts each quarter. The guidelines are developed with input from providers that have relevant clinical expertise. AIM guidelines also follow accreditation standards.
New, revised and clarified indications are announced as needed in the monthly medical policy updates announcement table.