New Cardiology Review Process for Services Performed on or after 1/1/2023

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is committed to promoting care that is appropriate, safe, and affordable for our members. With that in mind, we are pleased to announce that AIM Specialty Health (AIM) will review authorization of cardiovascular services for our Commercial Fully Insured members beginning December 19, 2022, for services performed on or after January 1, 2023.   

The goal of this new review process is to improve the clinical appropriateness of cardiovascular services through the application of evidence-based guidelines with expert cardiologist assessment in an efficient and effective review process.    

Review requirements 

Providers are strongly encouraged to verify that an authorization has been obtained before scheduling or in some cases after performing any elective cardiovascular service.    

Contact AIM to obtain authorization for the following non-emergency cardiovascular services: 

• Diagnostic Coronary Angiography with or without right or left heart catheterization   
• Percutaneous Coronary Intervention (PCI), such as coronary stents and balloon angioplasty   
• Arterial Duplex   
• Physiologic Study Arterial   
• Peripheral Revascularization   
• Implantable Cardioverter – Defibrillators   
• Cardiac Resynchronization Therapy   
• Permanent Pacemakers   

You can search the list of codes requiring Prior Plan Approval.

Procedures performed in an inpatient setting (i.e., those services performed during an inpatient stay) or on an emergent basis (i.e., those services performed as part of being evaluated at the ER and prior to the patient’s discharge from the hospital) are not included in the program. 

Eligible Members

To determine if a member requires prior authorization for enhanced cardiology services, either search using the member ID on the AIM portal or contact Blue Cross NC Customer Service using the phone number on the back of the member’s ID card.

How to Submit a Request for Review: 

Starting December 19, 2022, providers can begin submitting requests for review or verify order numbers using one of the following methods:   

Online 

The AIM ProviderPortal℠ is available 24/7, fully interactive, and processes requests in real-time using clinical criteria. To register, go to https://aimspecialtyhealth.com/providerportal/.   

By Phone 

Call AIM Specialty Health toll-free at 866-455-8414, Monday through Friday between 8:00 – 5:00 EST. 

For More Information:

For resources to help your practice get started with the cardiology review process, go to http://www.aimprovider.com/cardiology. 

The AIM provider website provides access to useful information and tools such as order entry checklists and clinical guidelines.   

To learn more about AIM, please visit www.aimspecialtyhealth.com.