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Cancer Care

Inpatient

We require authorization or pre-approval for inpatient requests for cancer treatment services for all members. Notification to Blue Cross is required. Go to our Prior Authorization Overview page for tips for submitting authorization requests

For FEP members, please check authorization requirements at fepblue.org.

Outpatient

Commercial and Medicare Advantage members

Quality Care Cancer Program takes effect July 1
The ProviderPortalSM and AIM contact center is open now for prior authorization requests with dates of service on and after the program effective date of July 1, 2021.

We require prior authorization for certain outpatient medical oncology and radiation oncology services through our Quality Care Cancer Program. The program is administered by AIM Specialty Health®', an independent company, so authorization requests should go directly to them.

Note: Indemnity members are not part of the Quality Care Cancer Program.

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How to request prior authorization with AIM Specialty Health

Ordering providers will request authorization with AIM in one of three ways:

  1. Through a direct link on this site (no additional registration is required). In the eTools tab, go to AIM Specialty Health(). Click the Go Now button.
  2. Go directly to the AIM ProviderPortal (registration is required) at www.providerportal.com.
    Note: If you’ve already registered for the AIM ProviderPortal for Blue Cross Blue Shield of Massachusetts or another insurer, you won’t need to register again.
  3. Call AIM’s Contact Center at 1-866-745-1783
    • Available Monday through Friday, 8 a.m. – 6 p.m. If you leave a voicemail after these hours, AIM will respond the next business day.
Information to have ready

Medical oncology services

Required information:

  • Member first, last name and date of birth
  • Ordering provider’s first and last name
  • Dispensing provider name
  • Place of service

Most order request also may require:

  • Clinical details
    • Patient height and weight
    • Diagnosis
    • Cancer type
    • Pathology and stage
  • Chemotherapy regimen
  • Biomarkers and tumor characteristics
  • Line of treatment

For order entry worksheets and checklists, click here.

Radiation oncology services

Required information:

  • Member first, last name and date of birth
  • Ordering provider’s first and last name
  • Primary cancer treatment being requested (for example, brachytherapy, IMRT, proton beam, etc.)
  • Patient diagnosis
  • Name and location of facility where treatment will be administered

Clinical data required:

  • Pre-Exam Questions (PEQ):
    • Patient’s height and weight
    • T, N, M status or stage of cancer
  • Cancer histology
  • Performance status, either Karnofsky or ECOG
  • Treatment goal, total dose, and number of fractions
  • For some situations, plan comparison with 3D or IMRT is required. This information is available on aimproviders.com/radoncology.
Getting an authorization decision (online)

After entering and reviewing your request, you’ll receive a summary. Approved orders will indicate “Authorized” and will include an “Order ID.” You’ll also see a summary of codes and disease information.

 

Information for servicing providers

To avoid a denied claim, servicing providers should use the AIM ProviderPortal to verify that an authorization is in place before the service is performed.

Resources

 Frequently Asked Questions
 S-code Fact Sheet

 Webinar slides: Medical Oncology
 Webinar slides: Radiation Oncology

 Frequently Asked Questions
 S-code Fact Sheet (log in required )

Federal Employee Program members

Federal Employee Program (FEP) members are not included in the Quality Care Cancer Program, but they may have authorization or pre-certification requirements for their outpatient cancer services. To check authorization requirements, please visit fepblue.org.