Prior Authorization Update - Pharmacy Medical Oncology

What's Changing: Blue Cross and Blue Shield of New Mexico (BCBSNM) is changing prior authorization requirements that may apply to some commercial and Blue Cross Community Centennial^SM members.

Starting October 11, 2021, AIM Specialty Health^® (AIM), rather than BCBSNM, will manage prior authorization requests for drugs in the Pharmacy Medical Oncology care category for some BCBSNM 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 BCBSNM.

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 BCBSNM will remain active with BCBSNM until the request expires, including dates before or after October 11, 2021.
• Contact BCBSNM to extend an active authorization for dates of service prior to October 11, 2021.
• Contact AIM via the ProviderPortal  to extend an active authorization for dates of service on or after October 11, 2021.
• Contact AIM for all authorizations initiated on and after October 11, 2021. Please use the AIM ProviderPortal for any new requests.
• Prior Determinations 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 Sep. 27, 2021 for dates of service on or after October 11, 2021.
• Do not submit prior authorization requests for Medical Oncology drug codes to BCBSNM for dates of service on or after October 11, 2021.
• Continue to submit prior authorization requests to BCBSNM through October 10, 2021, for dates of service before October 11, 2021.

More Information: Refer to the Prior Authorization section of our Provider website. The updated Specialty Drug Code list includes the drugs for Medical Oncology that AIM will review starting October 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 October 11, 2021.

There are two ways to register:

• Online – Go to the AIM ProviderPortal ; or
• For Commercial Members: By Phone – Call the AIM Contact Center at 866-7455-1789, Monday through Friday, 7 a.m. to 7 p.m., MT.
• For BCCC Members: By Phone – Call the AIM Contact Center at 877-291-0513, Monday through Friday, 7 a.m. to 7 p.m., MT.

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.

_{Such services are funded in part with the State of New Mexico.}

_{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 BCBSNM to provide utilization management services for members with coverage through BCBSNM. 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 BCBSNM. BCBSNM makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.}

_{CPT copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.}