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October 2018

Blue Cross PPO members who live outside Michigan will need prior authorization for certain services

Beginning Jan. 1, 2019, Blue Cross Blue Shield of Michigan will require prior authorization for PPO members who need certain services managed by AIM, regardless of where they live.

The services that require prior authorization include high-tech radiology, in-lab sleep management, proton beam therapy and echocardiogram services. Currently, members who reside in the state of Michigan already need prior authorization for these services. Starting Jan. 1, the program will expand to include those PPO members who live outside of Michigan and seek care from a Michigan provider.

You can find procedure code requirements on Benefit Explainer in web-DENIS. Log in to the provider portal, go to web-DENIS and select BCBSM Provider Publications and Resources. You can look up benefit and medical policy for procedure codes by selecting Benefit Policy for a Code.

Health care providers can request authorization for these services through the AIM ProviderPortalSM at aimspecialtyhealth.com or by contacting AIM at 1-800-728-8008.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
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