Transition of Member Care: Commercial Prior Authorization Change from eviCore to AIM
Posted December 4, 2020
On Oct. 1, 2020, we alerted you that 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).
The update below includes: Key dates to consider as we transition care for some members between eviCore and AIM; new contact information for AIM and hours of operation; and reminders on upcoming training dates.
Consider these key dates and scenarios during the transition of care between eviCore and AIM:
- Continue to submit prior authorization requests to eviCore through Dec. 31, 2020, for dates of service before or on Dec. 31, 2020.
- AIM’s ProviderPortal will be open for you to begin submitting prior authorization requests effective Dec. 21, 2020, for dates of service on or after Jan. 1, 2021.
- As of Jan. 1, 2021, commercial prior authorization requests must be submitted to AIM. Do not submit prior authorization requests to eviCore for dates of service on or after Jan. 1, 2021.
Join Us for A Webinar to Learn More
Please attend an online training session for more in-depth information on key dates, as well as a preview of the AIM ProviderPortal and BCBSIL-specific resources on the AIM website.
Other Important Reminders
Make sure you’re registered with AIM prior to Jan. 1, 2021. [If you’re already registered with AIM to submit Radiology Quality Initiative (RQI) requests for BCBSIL members, you don’t need to register again.] There are two ways to register:
- Online – Go to the AIM ProviderPortal ; or
- By Phone – Call the AIM Contact Center at 866-455-8415, Monday through Friday, 7 a.m. to 7 p.m., CT.
Member 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, prior to rendering services. This step will help you confirm coverage and other important details, such as prior authorization requirements and vendors, if applicable. 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.
For More Information
Continue to watch the News and Updates for reminders, announcements and educational resources that will help you transition to submitting commercial prior authorization requests through AIM.
Checking eligibility and/or benefit information and/or the fact that prior authorization or pre-notification has been completed 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 prior authorization/pre-notification through 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 independent that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 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.