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Commercial Prior Authorization Update: Pharmacy Medical Oncology

Posted July 7, 2021

What’s changing?
Blue Cross and Blue Shield of Illinois (BCBSIL) is changing prior authorization requirements that may apply to some commercial, non-HMO members.

Starting Oct. 11, 2021, AIM Specialty Health® (AIM), rather than BCBSIL, will manage prior authorization requests and post service medical necessity review for drugs in the Pharmacy Medical Oncology care category for some BCBSIL members.

Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested isn’t associated with an oncology diagnosis, it will be reviewed by BCBSIL.

Predetermination will no longer be offered for the Medical Oncology care category. All requests will be processed as a prior authorization.

Important Reminder: Check Eligibility and Benefits First
Always check eligibility and benefits through the Availity® Provider Portal  or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Key Dates and Scenarios as We Transition to AIM

  • Make sure you’re registered with AIM, prior to Oct. 11, 2021. You can register online via the AIM ProviderPortal , or call the AIM Contact Center at 866-455-8415, Monday through Friday, 7 a.m. to 7 p.m., CT.*
  • Continue to submit Pharmacy Medical Oncology prior authorization requests to BCBSIL through Oct. 10, 2021, for dates of service before Oct. 11, 2021.
    A prior authorization request initiated with BCBSIL will remain active with BCBSIL until the request expires, including dates before or after Oct. 11, 2021.
  • Contact BCBSIL to extend an active prior authorization for dates of service prior to Oct. 11, 2021.
    Do not submit prior authorization requests for Medical Oncology drug codes to BCBSIL for dates of service on or after Oct. 11, 2021.
  • AIM’s ProviderPortal  and call center will be begin accepting prior authorization requests on Sept. 27, 2021, for dates of service on or after Oct. 11, 2021.
  • Contact AIM via their ProviderPortal to extend an active prior authorization for dates of service on or after Oct. 11, 2021.
  • Contact AIM for all prior authorizations initiated on and after Oct. 11, 2021. Please use the AIM ProviderPortal for any new requests.

For More Information
Refer to the Utilization Management section of our Provider website for an updated 2021 Commercial Specialty Pharmacy Prior Authorization Drug List. This list is posted on the Support Materials (Commercial) page. It includes the drugs for Medical Oncology that AIM will review starting Oct. 11, 2021.

Provider Training
AIM will be hosting free webinars on how to use the AIM ProviderPortal to enter medical oncology prior authorization requests. The webinars are conducted by AIM. To register, select your preferred date and time from the list below:

*If you’re already registered with AIM to submit Radiology Quality Initiative (RQI) requests for BCBSIL members, you don’t need to register again.

Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.

AIM Specialty Health (AIM) is an independent company 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 AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.