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:

    • CT scan
    • MRI/MRA
    • Nuclear Cardiology
    • Echo
    • PET scan
    • Sleep study
    • Radiation oncology
    • Genetic testing: Available through AIM for dates of service beginning January 4, 2019. Learn more about genetic testing through AIM.

    View our code list to see which codes require review or log in and use our prior authorization tool.

    View AIM Clinical Appropriateness Guidelines (updated twice yearly).

    To request an order number, register with AIM and then submit your request online or by phone:

    An order number isn't required for the following:

    • Emergency room services
    • Inpatient hospitalization
    • Outpatient surgeries (hospitals and free-standing surgery centers)
    • 23-hour observations

    Verify prior authorization before scheduling

    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

    AIM clinical information checklist

    AIM order entry tip sheet