Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2020-12-07

This update provides information on how providers or facilities should request prior approval for medical oncology drugs. Adherence to the steps below will help avoid denial of submitted claims. Medical oncology drugs are currently being added to the Prior Plan Approval (PPA) list for the AIM Medical Oncology Program. The information below provides specific instructions and terminology used by AIM when prior authorization is officially given.

Key Points

  • A drug requiring PPA with AIM Medical Oncology with an effective date 1/1/2021 needs to be requested on or after 1/1/2021. Authorizations will not be approved by AIM before the drug is added to the PPA list.
  • For any providers or facilities requesting prior authorization for a specific drug listed with the AIM Medical Oncology program, drugs that have been officially approved will be listed as “Authorized” under the request status. 
  • Drugs with a status of “Completed” or “AIM Clinical Review Not Required” did not require an authorization by AIM at the time of the review but may be added to the Prior Plan Approval list during the course of the patient’s treatment. 

A listing of the CPT codes requiring Prior Approval along with who must be contacted can be found below:

https://www.bluecrossnc.com/providers/medical-policies-and-coverage/prior-plan-review

If you have any questions, please contact Customer Service at 1-877-275-9787. This phone number can also be found on the back of the member ID card.