As previously communicated, effective January 2, 2018, AmeriHealth will require precertification for services included under the expanded Cardiology Utilization Management Program* and new Musculoskeletal Utilization Management Program?. AmeriHealth has delegated the precertification process for these services to AIM Specialty Health? (AIM).
Submitting requests to AIM
Starting December 18, 2017, AIM will begin accepting precertification requests with dates of service on or after January 2, 2018, in an effort to facilitate care of members and knowing that these requests are typically sent in advance of the service date.
Ordering or performing providers can submit precertification requests for services included in these utilization management programs using AIM's ProviderPortalSM, which providers can access directly through AIM's website or through the NaviNet? web portal by selecting Authorizations from the Workflows menu and then AIM.
If there is a discrepancy between the procedure to be performed and the procedure that received precertification, the performing provider should consult with both the ordering provider and AIM to address the discrepancy and request any necessary changes to the authorization before rendering service.
For more information
Please refer to the following previously published announcements for more detailed information about the new AmeriHealth medical policies for each utilization management program:
To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial under Active Notifications.
Please also review our frequently asked questions (FAQ) for each utilization management program:
The FAQs can also be found on AmeriHealth NaviNet Plan Central in the Frequently Asked Questions section under Administrative Tools & Resources. Note: The FAQs may be updated if more information becomes available.
If you still have questions after reviewing the FAQs, please send an email to aimumprograms@amerihealth.com.
*The new precertification requirements that go into effect January 2, 2018, under the Cardiology Utilization Management Program are in addition to current precertification requirements for other cardiac services, including outpatient echocardiography and nuclear cardiology services.
?The Musculoskeletal Utilization Management Program is being implemented in two phases:
- Effective January 2, 2018, musculoskeletal joint and spine services will require precertification through AIM.
- Effective March 1, 2018, interventional pain management services will also require precertification through AIM.
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