AIM Specialty Health

  • AIM Specialty Health (AIM) manages prior authorization for select services for LifeWise Health Plan of Oregon. Prior authorization is required for certain procedures and services. Contracted providers are financially liable for providing services that are medically unnecessary. Providers must make prior authorization requests through AIM for members on plans that require it.

    Prior authorization is based on member benefits and eligibility at the time of service. It determines medical necessity, treatment appropriateness, and setting, through nationally recognized guidelines.

    The following services are subject to review by AIM:

    • Genetic testing
    • Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)
    • Radiation oncology
    • Sleep study

    View our code list to see which codes require review.

    View AIM Clinical Appropriateness Guidelines.

    To request a prior authorization, register with AIM and then submit your request online or by phone at 866-666-0776.

    Prior authorization isn't required for the following:

    • Emergency room services
    • Inpatient hospitalization
    • 23-hour observations

    Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. In addition, imaging providers must submit ordering/referring provider information, per guidelines from the Centers for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms.

    If you have further questions, please call AIM at 866-666-0776.

    AIM resources for providers