Effective January 1st, 2021, the nation’s 5th largest insurer, Blue Cross Blue Shield transitioned their prior authorization servicing to AIM Specialty Health from eviCore Healthcare for some states. BCBS Illinois, Texas, Oklahoma, New Mexico, and Montana now require physicians to submit prior authorizations through AIM for certain care categories, including Genetic Testing. Under the AIM Specialty Health program, laboratories are not permitted to submit prior authorization for a test on behalf of a physician. Previously, before the transition, the laboratory was able to complete the prior authorization on behalf of the physician.
Why Prior Authorization Submission Matters
In speaking with personnel familiar with this matter, the commercial plans (excluding Medicare and Medicaid) for Health Care Service Corporation (HCSC) membership are part of this transition. The AIM Clinical Guidelines for Genetic Testing routinely requires prior authorizations for certain genetic and molecular tests including pharmacogenomics, cardiac disease, cancer susceptibility, tumors, and malignancies.
How Does CMT Fit In?
CMT Solutions can help with these new requirements by performing physician-directed prior authorizations for the laboratory tests that fall under this program. We have a vast network of more than 35,000 physicians – our dedicated physician account management team can enroll your physician office quickly and efficiently, ensuring patients get the necessary testing and care.