Effective for dates of service on or after March 1, 2018, Independence will expand its Musculoskeletal Utilization Management Program to include select services for interventional pain management. Precertification for these interventional pain management services will be delegated to AIM Specialty Health® (AIM), an independent company, for all Independence members. AIM will use appropriate Independence policies or AIM Clinical Appropriateness Guidelines to help ensure that care aligns with established evidence-based medicine. In addition, AIM will review these services for setting.
Precertification requirements
For interventional pain management services that are scheduled on or after March 1, 2018, providers must contact AIM to request precertification for the following non-emergency modalities:
- epidural injections
- facet joint injections/medial branch blocks
- facet joint radiofrequency nerve ablation
- sacroiliac joint injections
- implanted spinal cord stimulators
Submitting requests to AIM
Ordering or performing providers can submit precertification requests for these services 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. Starting February 19, 2018, providers can begin submitting precertification requests to AIM for dates of service on or after March 1, 2018.
Note: When submitting precertification requests for interventional pain management services, you will be prompted to answer additional questions related to the setting of the requested services.
AIM's ProviderPortal is available seven days a week and offers providers the following:
- easy-to-use interface for efficient precertification requests;
- printable precertification summary information sheets for completed requests;
- online tracking of previous precertification requests and status of open requests.
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.
Policies and guidelines
Independence has expanded the policies listed below, which are currently posted as Notifications and will go into effect March 1, 2018, to include services for interventional pain management. Included within the policies are the specific Independence policies and a link to Clinical Appropriateness Guidelines that AIM will use during the precertification process, as well as a listing of procedure codes requiring precertification.
- Commercial: #00.01.66a: Musculoskeletal Services
- Medicare Advantage: #MA00.047a: Musculoskeletal Services
Note: The previous versions of these policies include musculoskeletal spine and joint services, and they will be implemented on January 2, 2018, as previously communicated.
To view the Notifications for these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Active Notifications.
More information
For questions about this program expansion, please review our Musculoskeletal Utilization Management Program: Frequently asked questions (FAQ), which can also be found on Independence NaviNet Plan Central in the Frequently Asked Questions section under Administrative Tools & Resources. Note: The FAQ will be updated as more information becomes available.
If you still have questions after reviewing the FAQ, please send an email to aim_umprograms@ibx.com.
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