June 2020
Recommendations for submitting authorization requests for medical oncology drugs to AIM
Here are some recommendations to follow when submitting authorization requests for medical oncology drugs to AIM Specialty Health®
- Wait to submit the request until you have all the pertinent information, including but not limited to:
- Tumor testing results
- Information on tumor staging and prior therapy regimens
- Wait to submit the request until you have all the pertinent information, including but not limited to, tumor testing results, information on tumor staging and prior therapy regimens.
- Provide all the clinical information needed for clinical review, including the rationale for the requested regimen.
- Ensure that the phone number you provide is accurate so AIM can contact you to schedule a peer-to-peer consultation if they need more information to establish medical necessity.
When you follow these guidelines, the process of reviewing authorization requests goes more smoothly and takes less time.
The information in this article applies to all members whose plans require authorization of medical oncology drugs by AIM:
- Medicare Advantage plans: Medicare Plus BlueSM and BCN AdvantageSM
- Commercial plans: BCN HMOSM and select Blue Cross PPO groups
How to submit authorization requests
For medical oncology drugs, submit authorization requests to AIM, using one of the following methods:
For information about registering for and accessing the AIM ProviderPortal, see the Frequently asked questions page on the AIM Specialty Health website.**
Lists of requirements
To see the requirements related to drugs covered under the medical benefit, including medical oncology drugs, refer to the following documents.
The specialty medications on these lists are administered in outpatient sites of care, including a physician’s office, an outpatient facility or a member’s home.
**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website. |