#Aim specialty health appeals how to#

Prior authorization services through eviCore are only for Medicare Advantage SM Plans. Services requiring prior authorization through eviCore ®:

By Phone – Call the Carelon Contact Center at 1-80 Monday through Friday, 6 a.m.

Online – Submit requests via the Carelon ProviderPortal 24/7.

Submit prior authorization requests to Carelon in one of the following ways:

#Aim specialty health appeals how to#

How to submit a prior authorization request through Carelon If you are already registered with Carelon you do not need to register again. Make sure you have an account with Carelon.

Cardiology (only required for certain members).

Faster pre-service decision turnaround times than post service reviewsīCBSOK requires preauthorization (for medical necessity) through Carelon for:.

Check prior authorization status on the Carelon ProviderPortal.

Carelon's ProviderPortal offers self-service, smart clinical algorithms and in many instances real-time determinations.

Do not submit medical records to BCBSOK for prior authorization or post-service reviews for the care categories managed by Carelon.Medical records for pre or post-service reviews are not necessary unless specifically requested by Carelon.Carelon is an independent company that provides specialty medical benefits management for BCBSOK. 1, 2021)īlue Cross and Blue Shield of Oklahoma (BCBSOK) has contracted with Carelon Medical Benefits Management to provide certain utilization management services. Services requiring prior authorization through Carelon Medical Benefits Management, formerly AIM Specialty Health ®, (Effective Jan. Call the phone number listed on the member’s ID card.Use BlueApprovR SM to request prior authorization for some services ( visit our BlueApprovR Provider Tools Page for instructions) Or.To learn more, visit Availity Authorizations & Referrals Or Submit via Authorizations & Referrals .Step 2: If prior authorization is required: Services requiring prior authorization through BCBSOK This will determine if prior authorization will be obtained through us or a dedicated vendor. Step 1: Confirm if prior authorization is required using Availity ® or your preferred vendor. For more information, please refer to your BCBSOK participating provider agreement. Benefits can be verified via the Availity ® Provider Portal or your preferred vendor or by contacting the customer service number listed on the back of the member's ID card.įailure to obtain preauthorization may result in a financial penalty. It is the responsibility of the rendering BCBSOK participating provider to verify eligibility and benefits prior to the date of service. An approved authorization of services by the Prior Authorization process is not a guarantee of benefits. Prior Authorization is a determination of medical necessity for the delivery of services. Should additional days of treatment be deemed necessary, it is the responsibility of the facility, treating physician or ancillary provider to request an extension in accordance with the BCBSOK participating provider agreement. Prior Authorization for an Extension of Approved Days Always check eligibility and benefits first, via the Availity ® Provider Portal or your preferred vendor, prior to rendering care and services.įor additional information, refer the Electronic Provider Access (EPA) FAQs located in the right navigation menu.

Other services may also require preauthorization.Inpatient admissions (scheduled and/or nonemergent), certain outpatient services, emergent admissions/obstetric (request authorization within two (2) business days of the admission), requests for extensions and Plan65 Members when their Medicare Part A benefits have been exhausted.Services which may require Prior Authorization The following outlines the process for providers to submit prior authorization requests.