Site of Service medical necessity reviews for a wide range of surgical procedures beginning January 1, 2021 for the City of NY Program.
Members enrolled in GHI-CBP/Empire BlueCross BlueShield plans will require a medical necessity review of the site of care for numerous surgical procedures performed in an outpatient hospital setting with dates of service on or after January 1, 2021.
The site of care review only applies to procedures performed in an outpatient hospital setting. The site of care review does not apply to procedures performed in a non-hospital setting or as part of an inpatient stay, nor when GHI-CBP/Empire BlueCross BlueShield is the secondary payer.
The site of care review will apply to a wide range of surgical procedures, including but not limited to the following specialty categories:
· Auditory system
· Digestive/Gastrointestinal system
· Eye/ocular adnexa system
· Female genital system
· Hemic and lymphatic system
· Integumentary system
· Male genital system
· Musculoskeletal system
· Nervous system
· Respiratory system
· Urinary system
For a complete list of procedures included in this site of care review, Frequently Asked Question and additional information, visit aimproviders.com/surgicalprocedures/resources. You should also review Clinical guideline Site of Care: Hospital-Based Ambulatory Surgical Procedures and Endoscopic Services, AIM Specialty Health® (AIM) will administer the review and providers may contact AIM to request a peer-to-peer discussion before or after the review is complete. Providers can view specific guidelines and preauthorization requirements for GHI-CBP/Empire BlueCross BlueShield members on the Preauthorization page of the BCBS provider website.
Submit a request for review to AIM for procedures covered by this policy
Starting December 23, 2020, and for dates of service after January 1. 2021, providers may submit preauthorization requests for the hospital outpatient site of care to AIM in one of the following ways:
· Online at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization. The AIM Provider Portal is only available to Empire BlueCross BlueShield contracted providers.
· Access AIM via the Availity Web portal at availity.com.
· Call the AIM Contact Center toll-free at 877-430-2288, Monday–Friday, 8:00 a.m.–6:00 p.m. ET.
Beginning in December, AIM will offer webinars to provide information on navigating the AIM ProviderPortal. To register for a webinar, visit aimproviders.com/surgical procedures.
Providers should continue to verify eligibility and benefits for all members prior to rendering services.
If you have questions, please call the Provider Service phone number on the back of the member’s ID card.