AIM Specialty Health® Helps Healthcare Providers Complete Prior Authorizations and Meet New CMS Medicare Requirements

By a News Reporter-Staff News Editor at Insurance Weekly News -- Healthcare providers can now complete their prior authorizations for high tech, diagnostic imaging services and comply with the appropriate use criteria program from the Centers for Medicare and Medicaid Services from a single source.

AIM Inform, a new solution from AIM Specialty Health®, integrates with EMR systems to fulfill prior authorization and CMS program requirements without the need to use separate systems. AIM Inform includes outpatient services for computed tomography, magnetic resonance imaging, and nuclear imaging exams.

AIM received designation to deliver appropriate use criteria for the CMS program addressing outpatient advanced imaging services. As part of U.S. health care reform efforts, effective Jan. 1, 2019, the program mandates that providers use CMS-approved clinical decision support criteria that documents the appropriateness of a high-tech, diagnostic imaging order to receive full reimbursement for Medicare fee-for-service beneficiaries.

"By eliminating the need for providers to use separate systems to fulfill prior authorization and CMS requirements, AIM Inform simplifies the provider workflow and helps reduce administrative costs and effort," said Brandon Cady, president and CEO of AIM. "As a result, providers can spend more time with their patients face-to-face and achieve real-time payment clarity and clinical determination."

AIM is one of a select group of organizations designated as a qualified clinical decision support mechanism. In 2016, AIM also became a collaborator in developing appropriate use criteria for the CMS program with the Center for Diagnostic Imaging Quality Institute, which became a designated provider led entity that year.

Through AIM Inform, providers and hospitals gain a streamlined option to purchase and install qualified systems by the CMS-published deadline. Eight clinical priority areas have been set by CMS to reduce the number of potentially inappropriate imaging exams. These priority areas align with a broad range of AIM clinical domains, including specific expertise in coronary artery disease, pulmonary embolism, and lung cancer. AIM Inform includes criteria from a number of PLEs, including the Center for Diagnostic Imaging Quality Institute, the National Comprehensive Cancer Network and the American College of Cardiology. About AIM AIM Specialty Health® provides clinical solutions that drive appropriate, safe and affordable care. Serving more than 50 million members across 50 states, D.C. and US territories, AIM promotes optimal care through use of evidence-based clinical guidelines and real-time decision support for both providers and their patients. The AIM platform delivers significant cost of care savings across an expanding set of clinical domains including radiology, cardiology, oncology, specialty drugs, sleep medicine, musculoskeletal, pain management and genetic testing. AIM is a wholly-owned subsidiary of Anthem, Inc. (ANTM). For more information, visit www.aimspecialtyhealth.com and www.aiminform.com. View source version on businesswire.com: http://www.businesswire.com/news/home/20170912005511/en/

Keywords for this news article include: Genetics, Medicare, Cardiology, Health Policy, Diagnostic Imaging, AIM Specialty Health, Diagnostics and Screening.

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