AIM may ask for clinical information for prior authorization requests

As part of its quality improvement efforts, AIM Specialty Health^® may ask for clinical information for prior authorization requests submitted for Blue Cross Blue Shield of Michigan commercial members, starting in the third quarter of 2022. Clinical information requested will apply to:

• All outpatient high-technology radiology procedures
• Some outpatient cardiology procedures

AIM may request the additional information as part of the prior authorization process. You’ll need to submit documentation from the member’s medical record that verifies the member’s condition.

AIM will review the clinical information and use it in determining the clinical appropriateness of the request. AIM is initiating this as part of their ongoing quality improvement efforts.

If the information you provide doesn’t support the medical necessity of the request, AIM may deny the request.

This won‘t apply to prior authorization requests submitted for Medicare Plus Blue℠ or BCN Advantage℠ members. This information is currently being requested for BCN select commercial prior authorization requests.

For more information about AIM’s requirements related to services for Blue Cross commercial members, visit our  Blue Cross AIM-Managed Procedures webpage at ereferrals.bcbsm.com.

AIM is an independent company that manages authorization requests for high-technology radiology and other services for many Blue Cross and BCN members.