BCBSM/BCN Dual Header The Record Header Logo

The Record - Insurance Card with the BCBSM/BCN Cross and Shield logo that reads, Blue Cross Blue Shield, Blue Care Network of Michigan. Tagline: Confidence comes with every card. Image of Note boards with paper that has the letters RX on it accompanied by a stethoscope

Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
October 2018

New utilization management programs beginning for URMBT members

Beginning Jan. 1, 2019, Blue Cross will implement two new utilization management programs for oncology services for UAW Retiree Medical Benefits Trust, or URMBT, non-Medicare members. With these programs, prior authorization must be obtained for some outpatient medical and radiation oncology treatments.

The programs, which promote evidenced-based, high-value care for our members, require prior authorization for radiation oncology and medical oncology services in outpatient settings. Prior authorization will be managed by AIM Specialty Health®.

The benefits of these programs include:

  • Synchronization with Blue Cross Blue Shield of Michigan’s medical policy
  • 24/7 access to the AIM ProviderPortalSM for automated clinical appropriateness review and access to the AIM contact center personnel, including oncology nurses and oncologists, during business hours
  • Actionable information — Includes a comprehensive set of current, evidence-based AIM Cancer Treatment Pathways for more than 80 clinical scenarios (medical oncology program only)
  • Enhanced reimbursement — By choosing an AIM Cancer Treatment Pathway regimen, when clinically appropriate, the ordering provider can receive enhanced reimbursement (to be billed using designated S-codes, only for the medical oncology program)

The affected codes for medical oncology and radiation oncology are on the Clinical Criteria & Resources page of the BCBSM Newsletters and Resources section of web-DENIS. Look in the AIM Specialty Health Resources section and click on URMBT Medical Oncology Prior Authorization List or URMBT Radiation Oncology Prior Authorization List.

Providers can also find procedure code preapproval requirements for members when checking benefits and eligibility on web-DENIS.

You can obtain authorization by going to the AIM ProviderPortal** or by calling AIM at 1-800-728-8008, beginning Dec. 24, 2018 (for services on or after Jan. 1, 2019).

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.