All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - June 2022
Premera Blue Cross·WA · Orthopedics, Neurosurgery, Cardiology +5 more·Medical Policy
Effective date
Sep 11, 2022
We identified it
Jun 18, 2026
Summary
Multiple AIM Specialty Health clinical appropriateness guidelines updated for advanced imaging, sleep disorder management, genetic testing, and various medical procedures. Changes include modified conservative management timeframes, new indications for imaging studies, updated genetic testing criteria, and revised medical necessity requirements for procedures like cervical spine surgery and hysterectomy.
Action Required
By September 11, 2022: Clinical and billing teams must update prior authorization processes to reflect new AIM Specialty Health guidelines. Key changes include: 1) Extend rotator cuff tear conservative management documentation from 4 to 6 weeks before imaging approval, 2) Update spine imaging protocols to require initial radiograph evaluation, 3) Modify genetic testing criteria for cardiac conditions and cancer screening, 4) Ensure cervical spine fusion documentation includes 12-month post-fusion imaging for pseudoarthritis cases, 5) Update Spravato authorization to require substance use screening documentation. Review all AIM guidelines in billing system and train staff on new requirements to avoid claim denials.