![]() Carelon Resources for ProvidersĬarelon Medical Benefits Management is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers. Serving more than 50 million members across 50 states, D.C. AIM Specialty Health® provides clinical solutions that drive appropriate, safe, and affordable care. ![]() If you have questions, call Carelon at 86. AIM Specialty Health 6,344 followers on LinkedIn. In addition, servicing providers must submit ordering/referring provider information, per guidelines from theĬenters for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. Prior authorization isn't required for the following: Glassdoor has 358 AIM Specialty Health reviews submitted anonymously by AIM Specialty Health employees. To request a prior authorization, register with Carelon and then submit your request online or by phone at 86. Good culture Competitive pay Growth opportunities. Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)Ĭode list to see which codes require review.Ĭarelon Clinical Appropriateness Guidelines.The following services are subject to review by Carelon: It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. Prior authorization is based on member benefits and eligibility at the time of service. Providers must make prior authorization requests through Carelon for members on plans that require it. Prior authorization is required for certain procedures and services.Ĭontracted providers are financially liable for providing services that are medically unnecessary. They are associated with a reduced cost of care without compromising quality of care.AIM Specialty Health is officially changing its name to Carelon Medical Benefits Management on March 1, 2023.Ĭarelon Medical Benefits Management (formerly AIM) manages prior authorization for select services for Premera Blue Cross. ![]() Pathway regimens for breast cancer demonstrate an example of high-value care. The two cohorts had similar rates of hospitalization and emergency department visits however, the rate of granulocyte colony-stimulating factor use was significantly lower in the on-pathway cohort (72.5% in the on-pathway cohort v 82.8% in the off-pathway cohort odds ratio, 0.55 P ≤. The estimated base pay is 101,266 per year. This number represents the median, which is the midpoint of the ranges from our proprietary Total Pay Estimate model and based on salaries collected from our users. Patients in both cohorts had a similar age distribution (median age, 52 years in the off-pathway cohort v 53 years in the on-pathway cohort), and most presented with stage II disease (49.4% in the off-pathway cohort v 49.8% in the on-pathway cohort) nearly two thirds of each cohort had hormone receptor positive cancer (67.3% in the off-pathway cohort v 64.9% in the on-pathway cohort). The estimated total pay for a Client Management Executive at AIM Specialty Health is 112,908 per year. There were 959 patients in each cohort after matching. We compared post-6-month quality-of-care outcomes including hospitalization, emergency department visits, need for supportive drugs such as granulocyte colony-stimulating factor, and cost outcomes between the cohorts. On the basis of demographic and clinical characteristics, patients receiving a pathway regimen (on-pathway cohort) were matched to those who did not (off-pathway cohort) using 1:1 propensity score matching. Using nationally representative claims data from Anthem, together with clinical data from its Cancer Care Quality Program, we identified patients with breast cancer for whom chemotherapy was initiated between January 2015 and October 2016. There are few real-world data to support the value of such regimens, especially for patients with breast cancer. Pathway regimens are value-driven, evidence-based therapies that aim at high-quality, affordable cancer care.
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