Issue resolved: Medical oncology drug claims were denying in error even with authorization from AIM

Our systems have been incorrectly denying some medical oncology drug claims for lack of authorization. These claims were denied despite providers having obtained prior authorization, as required, through AIM Specialty Health^®.

We've identified and resolved an issue that was preventing authorizations from automatically transferring from the AIM system into the Blue Cross and BCN e-referral system. As a result:

• When you submit these claims in the future, they will not deny incorrectly. The authorization will automatically transfer from the AIM system into the e-referral system.
• We will reprocess claims that were incorrectly denied. You won’t need to resubmit them.

The problem was affecting medical oncology drug claims for:

• Members covered through Blue Cross commercial fully insured groups except Michigan Education Special Services Association members
• Blue Cross commercial members with individual coverage
• BCN commercial members
• BCN Advantage^SM members
• Medicare Plus Blue^SM members

If you have questions, call the Pharmacy Help Desk at 1-800-437-3803.

We apologize for the problems caused by this issue and we thank you for your patience while we resolved it.

Posted: April 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network