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Preapproval Requirements

Updated November 2018

Preapproval reviews are conducted by UniCare’s Managed Care department or by AIM Specialty HealthSM, a UniCare-affiliated company that provides support for the preapproval process. Our Provider Reference Sheet identifies which services are reviewed by UniCare and which are reviewed by AIM and how much notice is required (see below).

You can also download our precertification worksheets and the standardized prior authorization form.

Provider Reference Sheet

Use this resource as a convenient reference for member copays, notification requirements for preapprovals, and selected procedures for pre-review. View the preapproval requirements effective July 1, 2018.

New preapproval requirement for hyaluronic acid injections to the knee on January 1, 2018 – Starting January 1, 2018, UniCare will require preapproval review for hyaluronic acid injections to the knee. This requirement applies to members in our Basic, Community Choice and PLUS plans only; it does not apply to Medicare Extension members. The following notice will be required:

You can also visit our member page to view notification requirements for preapprovals documents provided to members. Please refer to the applicable member handbook for more information on plan benefits, conditions, limitations and exclusions.

Who to notify

For UniCare reviews

UniCare Provider Services 800-442-9300

For AIM reviews
Aim Specialty HealthSM reviews certain services, procedures and specialty drugs.

Contact AIM directly:

For Express Scripts reviews of certain non-oncology specialty drugs
(for non-Medicare members only)

Express Scripts
855-283-7679

About AIM’s web-based application – UniCare’s partnership with AIM lets our providers use AIM’s web-based application for services reviewed by AIM. Providers can log into the AIM application and complete the intake process for certain procedures, as noted in our Provider Reference Sheet (see above). In many cases, the entire review and approval process can be done online. Providers who already use AIM’s web application will not have to re-register for UniCare.

Express Scripts, the new administrator for the prescription drug plan for UniCare's non-Medicare members starting July 1, 2018, covers and dispenses self- or office-administered specialty drugs (non-oncology). In addition, some specialty drugs require review and dispensing by Express Scripts, for non-Medicare members only. The list of these specialty drugs is updated periodically and posted on this site. View the current list effective October 1, 2018.

Forms

Important Notices

Updates to AIM guidelines for cardiac imaging effective January 28, 2019 – Beginning with dates of service on or after January 28, 2019, AIM Specialty Health® is revising its guidelines for certain cardiac imaging procedures. You can also view the complete text of the updated guidelines at www.aimspecialtyhealth.com.

An expanded review will be required for certain infused specialty drugs
If a non-Medicare member will be getting infusions of certain non-oncology specialty drugs in a hospital outpatient setting, an expanded review will be conducted to review both the drug for clinical appropriateness and the level of care/site of service. Learn more about this change.

See the Provider Reference Sheet above for a link to the lists of specialty drugs that will require level of care review.


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