Carelon resources for providersĬarelon Medical Benefits Management is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers. If you have questions, call Carelon at 86. In addition, servicing providers must submit ordering/referring provider information, per guidelines from theĬenters for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. The new number will not be applicable to Medicare or Commercial lines of business for Anthem. The previous AIM number will still be available for providers to use however, Anthem providers will need to dial the newly created number for Indiana Medicaid. Prior authorization isn't required for the following: The anticipated go-live date is September 1, 2021. To request a prior authorization, register with Carelon and then submit your request online or by phone at 86. These PA requests are often reviewed based on provider attestation of certain requirements. Providers currently submit prior authorization (PA) requests to AIM Specialty Health ® (AIM) for outpatient diagnostic imaging services. Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)Ĭode list to see which codes require review.Ĭarelon Clinical Appropriateness Guidelines. Support documentation for AIM prior authorization requests.The following services are subject to review by Carelon: It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. Prior authorization is based on member benefits and eligibility at the time of service. Providers must make prior authorization requests through Carelon for members on plans that require it. The new phone numbers are listed below and will go into effect on April 1, 2022. Prior authorization is required for certain procedures and services.Ĭontracted providers are financially liable for providing services that are medically unnecessary. AIM Specialty Health (AIM) has created a new AIM contact center phone number for providers to use to call in prior authorization requests for Anthem Blue Cross and Blue Shield (Anthem). Medical Benefits Management (formerly AIM) manages prior authorization for select services for Premera Blue Cross. Initiating a request on AIM’s ProviderPortal SM for PT/OT/ST and entering all the requested clinical questions will allow you to receive an immediate determination. Call the AIM Contact Center toll-free number at 1-80 from 7 a.m. AIM Specialty Health is officially changing its name to Carelon Medical Benefits Management on March 1, 2023. Providers may submit prior authorization requests to AIM in one of several ways.
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