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Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021

Posted October 1, 2020

What’s changing?
The utilization management vendor that processes prior authorizations for some of our commercial members is changing. Starting Jan. 1, 2021, prior authorization requests for commercial Blue Cross and Blue Shield of Illinois (BCBSIL) members that are currently required to be submitted through eviCore healthcare (eviCore) will require prior authorization through AIM Specialty Health® (AIM). This change will apply to some BCBSIL members with the commercial PPO products (networks) listed below:

  • PPO (PPO)
  • Blue Choice Preferred PPOSM (BCE)
  • Blue Choice PPOSM (BCS)
  • Blue OptionsSM/Blue Choice OptionsSM (BCO)
  • Blue High Performance NetworkSM (Blue HPNSM)

 What’s not changing?
The care categories that currently require prior authorization will stay the same:

  • Advanced imaging*
  • Cardiology
  • Sleep medicine
  • Pain management
  • Joint and spine surgery
  • Radiation therapy
  • Genetic testing

*Note: AIM will continue to administer our Radiology Quality Initiative (RQI) program for most members whose benefit plans do not require prior authorization for advanced imaging services. 

If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member. Learn more about prior authorization in BCBSIL on our website, which includes code lists for the services that may require prior authorization. Remember, these code lists are not exhaustive and are updated periodically.

It’s important to remember that benefits will vary based on the service being rendered and individual and group policy elections. Always check eligibility and benefits first, through the Availity® Provider Portal  or your preferred web vendor. This step will help you confirm coverage and other important details, such as prior authorization requirements and vendors, if applicable.

How can you prepare for this transition?
Make sure you’re registered with AIM so you can submit prior authorization requests.

  • Online – Go to the AIM ProviderPortal  to register; or
  • By Phone – Call the AIM Contact Center at 800-859-5299, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays.

If you’re already registered with AIM to submit RQI requests for BCBSIL members, you don’t need to register again. 

How to Submit Prior Authorization Requests through AIM Starting Jan. 1, 2021
Submit prior authorization requests to AIM in one of the following ways:

  • Online – Submit requests via the AIM ProviderPortal , 24/7.  
  • By Phone – Call the AIM Contact Center at 800-859-5299, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays.

For More Information
Watch the News and Updates for dates and times of upcoming trainings that will help you transition to submitting prior authorization requests through AIM.

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. Certain employer groups may require preauthorization/pre-notification for imaging services from other vendors. If you have any questions, please call the number on the member's ID card.

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. eviCore is wholly responsible for its own products and services. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.