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Self-funde​d groups must elect to participate in vendor-based utilization management programs​​​

December 16, 2019

As previously communicated in a Partners in Health UpdateSM article, Independence implements various utilization management programs through third-party vendors to ensure members receive high-quality care that is appropriate, safe, and cost-effective. These programs, which are based on established evidence-based guidelines and industry standards, reflect our commitment to being good stewards of our members’ health care dollars.

These programs expand our existing list of utilization management programs. However, self-funded groups can elect not to include these utilization management programs as part of their group health plan.   ​​​​

Identifying Independence members who are in a self-funded group that has elected not to participate in our utilization management programs

Because some self-funded groups may elect not to participate in our utilization management programs, it is important to submit all authorization requests for services included in our utilization management programs directly to our designated vendors:

  • AIM Specialty Health® (AIM), an independent company
  • CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent specialty benefit management company

If an Independence member is part of a self-funded group that has elected not to include utilization management programs in their group health plan, the authorization request will be returned with a message indicating that an authorization is not required for the service.

All other Independence members still require authorization for these services.

Learn more

If you have questions related to services in our utilization programs that require authorization, visit our dedicated web pages for AIM and eviCore.

If you have additional questions after reviewing these materials, please call Customer Service at 1-800-ASK-BLUE (1-800-275-2583).

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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