Prior Authorization Update — Pharmacy Medical Oncology

July 1, 2021

What’s Changing: Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements that may apply to some commercial members.

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

Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested is not associated with an oncology diagnosis, it will be reviewed by BCBSOK.

Important Reminder: Always check eligibility and benefits first 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.

Keep in mind these key dates and scenarios as we transition to AIM:

• Authorizations initiated with BCBSOK will remain active with BCBSOK until the request expires, including dates before or after Oct. 11, 2021.
• Contact BCBSOK to extend an active authorization for dates of service prior to Oct. 11, 2021.
• Contact AIM via the ProviderPortal to extend an active authorization for dates of service on or after Oct. 11, 2021.
• Contact AIM for all authorizations initiated on and after Oct. 11, 2021. Please use the AIM ProviderPortal for any new requests.
• Predeterminations will no longer be offered for the Medical Oncology care category. All requests will be processed as a prior authorization.
• 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.
• Do not submit prior authorization requests for Medical Oncology drug codes to BCBSOK for dates of service on or after Oct. 11, 2021.
• Continue to submit prior authorization requests to BCBSOK through Oct. 10, 2021, for dates of service before Oct. 11, 2021.

More Information: Refer to the Utilization Management section of our Provider website. The updated Specialty Drug Code list includes the drugs for Medical Oncology that AIM will review starting Oct. 11, 2021. Find the Specialty Drug Code list here .

Find information about our prior authorization program with AIM at this microsite.

Other Important Reminders: Make sure you’re registered with AIM, prior to Oct. 11, 2021.

There are two ways to register:

• Online — Go to the AIM ProviderPortal; or
• By Phone — Call the AIM Contact Center at 888-240-3085, Monday through Friday, 7 a.m. to 7 p.m., CT.

Join Us for A Webinar to Learn More: It’s important to attend an online training session for more in-depth information on key dates. You can also get a preview of the AIM ProviderPortal and the Medical Oncology program. Visit the AIM microsite for links to future training dates or register using the links below.

For More Information: Continue to watch the News and Updates for reminders, announcements and educational resources that will help you transition to submitting prior authorization requests through AIM.

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 BCBSOK to provide utilization management services for members with coverage through BCBSOK. 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 BCBSOK. BCBSOK 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.

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