Blue Cross and Blue Shield of New Mexico (BCBSNM) has contracted with AIM to provide certain utilization management prior authorization services for certain Commercial, Retail and ASO members and Blue Cross Community Centennial Members. Services requiring prior authorization through AIM are outlined below. AIM is an independent company that provides specialty medical benefits management for BCBSNM.
Use the AIM ProviderPortal for Pre & Post-Service Reviews
Use the AIM ProviderPortal to request prior authorization and respond to post-service review requests by AIM. Do not submit medical records to BCBSNM for prior authorization or post-service reviews for the care categories managed by AIM. Medical records may or may not be needed for pre or post service reviews using the AIM portal due to the smart clinical algorithms within the portal.
Benefits of the AIM ProviderPortal for Pre & Post-Service Reviews
- Medical records for pre or post-service reviews are not necessary unless specifically requested by AIM.
- AIM's ProviderPortal offers self-service, smart clinical algorithms and in many instances real-time determinations
- Check prior authorization status on the AIM ProviderPortal
- Increase payment certainty
- Faster pre-service decision turnaround times than post service reviews
Services requiring prior authorization through AIM:
- Molecular and Genomic Tests
- Terapia de radiación
- Advanced Imaging
- Musculoskeletal
- Tratamiento del dolor
- Joint Surgery
- Cirugía de la columna vertebral
- Sleep Studies (for ASO and Fully Insured Members with health advocacy solutions or Wellbeing Management plan options).
- Select Outpatient Procedures (see CPT Code list in the section below)
Use the AIM ProviderPortal for Pre & Post-Service Reviews
Use the AIM ProviderPortal to request prior authorization and respond to post-service review requests by AIM. Do not submit medical records to BCBSNM for prior authorization or post-service reviews for the care categories managed by AIM. Medical records may or may not be needed for pre or post service reviews using the AIM portal due to the smart clinical algorithms within the portal.
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.
AIM Contact Information
Via Phone: (800) 859-5299
Online: through the AIM ProviderPortal
* Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Prior authorization of a service is not a guarantee of payment of benefits. El pago de los beneficios está sujeto a varios factores, que incluyen pero no se limitan a, la elegibilidad al momento de la prestación del servicio, el pago de primas/contribuciones, montos permitidos para los servicios, documentación médica complementaria y otros términos, condiciones, limitaciones y exclusiones establecidas en el Folleto del Certificado de Beneficios y/o la Descripción Resumida de la Cobertura, así como el período de espera por condición preexistente, si los hubiere.El pago de los beneficios está sujeto a varios factores, que incluyen pero no se limitan a, la elegibilidad al momento de la prestación del servicio, el pago de primas/contribuciones, los montos permitidos para los servicios, la documentación médica complementaria y otros términos, condiciones, limitaciones y exclusiones que se indican en el certificado de la póliza del asegurado o en el certificado de beneficios y servicios médicos, o en la descripción del resumen de cobertura. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.