AIM Specialty Health® (AIM) Precertification/Preapproval for Select Musculoskeletal Services for Medicare Advantage Members

    The Company requires precertification/preapproval through AIM Specialty Health® (AIM) for select musculoskeletal services for most members enrolled in its Medicare Advantage HMO and PPO products. To direct the application of these services for these members, AIM utilizes Medicare guidelines (e.g., National Coverage Determinations [NCD], Local Coverage Determinations [LCD]), or, in the absence of Medicare guidelines, Company medical policy. Additionally, there are certain services for which AIM’s Clinical Appropriateness Guidelines for Musculoskeletal* are applied during the precertification/preapproval process.

    For more information about the musculoskeletal services that require precertification/preapproval, and for a list of services that follow Company medical policy or AIM Guidelines, refer to the current version of medical policy #MA00.047: Musculoskeletal Services.

    *AIM’s medical necessity guidelines are consistent with the clinical appropriateness criteria based on technology assessment, peer-reviewed medical literature including clinical outcomes research and consensus opinion in medical practice. To access the AIM Clinical Appropriateness Guidelines for Musculoskeletal, click here.

    Issued on - 01/02/2018

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