Effective January 2, 2018, AmeriHealth is implementing a Cardiology Utilization Management Program to include non-emergency cardiovascular tests/diagnostic procedures and nonsurgical treatments for obstructive coronary artery disease. Precertification for these services will be delegated to AIM Specialty Health^® (AIM) for all AmeriHealth members.

Precertification requirements

For dates of service on or after January 2, 2018, precertification will be required for the following non-emergent tests and procedures and will be delegated to AIM for evaluation of medical necessity:

• Cardiovascular tests/diagnostic procedures:
  • – Coronary angiography
  • – Peripheral arterial ultrasound
• Nonsurgical treatments for obstructive coronary artery disease:
  • – Percutaneous coronary intervention (PCI), including:
    • Balloon angioplasty
    • Stents
    • Atherectomy

Submitting requests to AIM

Ordering or performing providers can submit precertification requests for these services using AIM's ProviderPortal^SM, which providers can access directly through AIM's website or through the NaviNet^® web portal by selecting Authorizations from the Workflows menu and then AIM. Starting December 18, 2017, providers can begin submitting precertification requests to AIM for dates of service on or after January 2, 2018.

AIM's ProviderPortal is available seven days a week and offers providers the following:

• easy-to-use interface for efficient precertification requests;
• printable precertification summary information sheets for completed requests;
• online tracking of previous precertification requests and status of open requests.

If there is a discrepancy between the procedure to be performed and the procedure that received precertification, the performing provider should consult with both the ordering provider and AIM to address the discrepancy and request any necessary changes to the authorization before rendering service.

Policies and guidelines

For more information, please refer to Medical Policy #11.02.27: Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound, which is currently posted as a Notification and will go into effect January 2, 2018. The medical policy includes a link to Clinical Appropriateness Guidelines that AIM will use during the precertification process, as well as a listing of procedure codes requiring precertification.

To view the Notification for this medical policy, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Commercial under Active Notifications.

More information

For questions about this new program, please review our Cardiology Utilization Management Program: Frequently asked questions (FAQ), which can also be found on AmeriHealth NaviNet Plan Central in the Frequently Asked Questions section under Administrative Tools & Resources. Note: The FAQ will be updated as more information becomes available.

If you still have questions after reviewing the FAQ, please send an email to aimumprograms@amerihealth.com.

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