In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Virginia: Anthem Health Plans of Virginia, Inc. and underwritten by Matthew Thornton Health Plan, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO products underwritten by HMO Colorado, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc.
(RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. In Maine: Anthem Health Plans of Maine, Inc.
In Kentucky: Anthem Health Plans of Kentucky, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Connecticut: Anthem Health Plans, Inc. November 2019 Anthem Provider News - IndianaĪnthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. * Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
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ET.įor questions related to guidelines, please contact AIM via email at Additionally, you may access and download a copy of the current and upcoming guidelines here. Call the AIM Contact Center toll-free number 80, Monday – Friday, 8:30 a.m.Access AIM via the Availity Web Portal at.Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization. Access AIM’s Provider Portal SM directly at.Allow active nicotine use as a risk factor for pseudoarthrosis in graft failureĪs a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:.Bone Graft Substitutes and Bone Morphogenetic Proteins.Allow thoracic fusion similar to lumbar.Allow active nicotine use as a risk factor in lumbar uses of bone growth stimulation.Noninvasive Electrical Bone Growth Stimulation.Aligned conservative care duration with discectomy criteria.Decreased duration of conservative care required for known spinal stenosis based on guidance from NASS and less evidence for efficacy of conservative management in this population.Excluded anterior lumbar interbody fusion for foraminal stenosis without evidence of instability exclusion due to very low quality evidence for efficacy.Decreased duration of conservative management required based on lower evidence for efficacy in spinal stenosis and specialty panel feedback.Consolidated juvenile and congenital in adolescent idiopathic.Inclusion for implant failure similar to cervical spine.Lumbar Fusion and Treatment of Spinal Deformity (including Scoliosis and Kyphosis).Added exclusions criteria of Prior spine surgery of any form at the target level.Added age, level requirements, and symptom/sign requirement and clarified contraindications in reflect these changes.Changed the duration of conservative management from 1 year to 6 months based on the FDA prospective study that was done to approve the lumbar disc arthroplasty procedure.Addition of physical therapy or home therapy requirement and one complementary modality for all spine procedures based on preponderance of benefit over harm to conservative care.Policy Updates / Medical Policy & Clinical GuidelinesĮffective for dates of service on and after February 9, 2020, the following updates will apply to the AIM Musculoskeletal Program Spine Surgery Clinical Appropriateness Guidelines.
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