What happens if I do not contact AIM for preauthorization of genetic testing??
If you contact the health plan, you will be directed to use the AIM ProviderPortal or call the AIM contact center. Contacting AIM prior to the performance of a test will provide you the information of whether or not the test is medically necessary and therefore a covered benefit for the member.
How do I know if my patient requires preauthorization for genetic testing?
A provider can look up their patient on the AIM portal. The portal will allow the user to proceed with the case if the member is included in the program.
If the patient is not found in the AIM database, does this mean that a request does not need to be entered for the member?
If a patient is not found in the AIM database, we recommend contacting the health plan to verify the necessary preauthorization requirements for that patient.
When the health plan is not the member's primary insurance, does this program apply to the member?
No, the program only applies to members who have the health plan as primary.
Who can submit order requests?
Ordering providers or a member of their staff may submit order requests for genetic testing. The preferred method is via the ProviderPortal.
How do I use the AIM ProviderPortal to submit my request?
A step-by-step tutorial on using the AIM ProviderPortal to submit your request can be accessed by going to www.providerportal.com.
What date of service should be included on the request for prior authorization?
Please complete the date of service field with the date that the laboratory likely will begin the testing process. Do NOT use the date the sample is collected unless the test is being performed by the laboratory on that same day. If the exact test date is unknown, please enter an estimated date that is one to three days after the sample is scheduled to arrive at the laboratory; doing so will facilitate approvals in the vast majority of situations.
What information is needed to submit a genetic testing order request?
AIM has developed a number of genetic testing order request worksheets outlining what information is helpful in order to submit a request for genetic testing. These worksheets can be found here
Once a request has been submitted, how long will it take to receive a response from AIM?
Requests that meet criteria receive a response instantly through the AIM ProviderPortal or on the phone with the AIM contact center. Request that require further review may take up to 5 days, although this may vary by plan and state.
After a case is completed, is a letter sent to the provider as to whether the services was approved or denied?
Yes. Generally speaking, the ordering provider will receive written notification of the final decision. In addition, the ordered tests and approvals, including an order number, can be obtained immediately online through ProviderPortal.
How long is an order number valid?
Once an order request has been submitted, the order summary will provide the valid timeframe of the authorization; although it is typically 90 days.