​Utilization management program – AIM®

Precertification has been delegated to AIM Specialty Health (AIM), an independent company, for:

  • Cardiology Utilization Management Program
  • Musculoskeletal Utilization Management Program
  • Precertification for diagnostic imaging services
  • Sleep studies

Cardiology Utilization Management Program

 

Precertification is required for certain cardiovascular tests/diagnostic procedures and certain nonsurgical treatments for obstructive coronary artery disease and is delegated to AIM for evaluation of medical necessity.

Policies and guidelines

 

Please review the following policies for the specific Independence policies and a link to Clinical Appropriateness Guidelines that AIM uses during the precertification process, as well as a listing of procedure codes requiring precertification on our Medical Policy Portal:

  • Commercial: #11.02.27: Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound
  • Medicare Advantage: #MA11.113: Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound

FAQ

 

To see the complete list of the non-emergent tests and procedures that will be delegated to AIM and how to submit precertification requests, please review our Cardiology Utilization Management Program: Frequently asked questions (FAQ).

If you still have questions after reviewing the FAQ, please send an email to aim_umprograms@ibx.com.


Musculoskeletal Utilization Management Program

 

Precertification is required for certain surgical procedures of the spine and joint and interventional pain management procedures and is delegated to AIM for evaluation of medical necessity.

Policies and guidelines

 

Please review the following policies for the specific Independence policies and a link to Clinical Appropriateness Guidelines that AIM uses during the precertification process, as well as a listing of procedure codes requiring precertification on our Medical Policy Portal:

  • Commercial: #00.01.66: Musculoskeletal Services
  • Medicare Advantage: #MA00.047: Musculoskeletal Services

FAQ

 

To see the complete list of surgical procedures of the spine and joint and interventional pain management procedures, please review our Musculoskeletal Utilization Management Program: Frequently asked questions (FAQ).

If you still have questions after reviewing the FAQ, please send an email to aim_umprograms@ibx.com.


Precertification for diagnostic imaging services

 

Precertification is required for outpatient nonemergent diagnostic imaging services and certain high-technology radiology services for our managed care members.

Ordering physicians — PCPs or specialists — are required to obtain precertification for the following outpatient nonemergent diagnostic services:

  • CT/CTA scans
  • CCTA/FFR
  • echocardiography
  • MRA
  • MRI
  • nuclear cardiology services
  • PET scans
  • PET/CT fusion

    Reviews for the above services will be performed by AIM according to Medical Necessity criteria.

    For more information and a complete list of our high-technology radiology services, please refer to the following Independence policies on our Medical Policy Portal:

    • Commercial: #09.00.46t: High-Technology Radiology Services
    • Medicare Advantage: #MA09.002f: High-Technology Radiology Services

    Sleep studies

     

    Precertification is required through AIM for sleep studies and continuous positive airway pressure (CPAP) titration studies in facility-based settings. Home-based sleep study tests do not require precertification.

    DME providers are required to obtain preapproval/precertification for APAP, BPAP, and CPAP (PAP) machines and their replacement supplies (e.g., tubing, water chambers, face masks).

    Policies and guidelines

    For more information about sleep testing services, please refer to the following Independence policies:

    Commercial

    • #07.03.01: Home Based Sleep Studies
    • #07.03.05x: Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies

    Medicare Advantage

    • #MA07.028: Home Based Sleep Studies
    • #MA07.058i: Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies

    To view these policies, visit our Medical Policy Portal. The policies include an updated code list.

    Information about AIM’s Sleep Disorder Management guidelines is included in Medical Policies #07.03.05x and #MA07.058i. AIM uses these guidelines during the precertification process to determine medical necessity for facility-based sleep testing.


    For more information

     

    Please refer to the Clinical Services – Utilization Management or the Specialty Programs sections of the Provider Manual for Participating Profession Providers for more information on preapproval/precertification through AIM.

    Communications