Blue Cross and Blue Shield of North Carolina to Add Additional Codes to the Enhanced Cardiology Review Program Effective Apr. 1, 2023

On Nov. 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced a new collaboration with AIM Specialty Health (AIM) (known as Carelon Medical Benefits Management, effective Mar. 1, 2023) to offer a new Enhanced Cardiology Review program.

Effective Apr. 1, 2023, additional procedures requiring medical necessity review will be added to the Enhanced Cardiology program for Fully Insured Commercial Members only, offered through AIM (Carelon). For most services, the review will take place prior to rendering the service, but where needed, post-service review will be accommodated. Providers are strongly encouraged to verify that an authorization has been obtained before scheduling or in some cases after performing any elective cardiovascular service.

Beginning Mar. 13, 2023, providers should contact AIM (Carelon) for authorization of services on or after Apr. 1, 2023, for the following procedures:

Percutaneous Coronary Intervention (PCI), such as coronary stents and balloon angioplasty *

• Arterial Duplex *
• Peripheral Revascularization *
• Implantable Cardioverter – Defibrillators
• Cardiac Resynchronization Therapy
• Permanent Pacemakers

* If a post services authorization becomes necessary for the following modalities: Arterial duplex, Peripheral revascularization and Percutaneous coronary intervention, the provider will need to initiate the request through AIM (Carelon) within 10 business days of the date of service.

To place an order request, you can submit prior authorization requests to AIM (Carelon) using one of the following methods:

Online

Get fast, convenient online service via the AIM (Carelon) ProviderPortal (registration required). ProviderPortal is available 24 hrs/day, 7 days/week. Go to Provider Portal to begin.

By phone

• Call AIM Specialty Health (Carelon) toll-free at 866-455-8414
• Hours: Monday – Friday 8:00 – 5:00 PM (EDT)

If you have other colleagues in your practice who will be submitting prior authorization requests, we encourage you to share this notice with them.