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Frequently Asked Questions


About the Medical Oncology Program

What is the Medical Oncology Program?
The Medical Oncology Program is an innovative quality initiative bringing physician practices evidence-based cancer treatment information that will allow you to compare planned cancer treatment regimens against evidence-based clinical criteria. The program also identifies certain evidence-based AIM Cancer Treatment Pathways. By choosing designated AIM Cancer Treatment Pathways, your practice becomes eligible for enhanced reimbursement.

How does the Medical Oncology Program benefit my practice?
Practices participating in the Program can gain efficiency through:

  • Synchronization with health plan Medical Policy and Clinical Guidelines
  • Identification of Pathway regimens which may be eligible for enhanced reimbursement
  • 24/7 online access to the AIM ProviderPortalSM, a proven technology platform to process your requests in real time

How will the Program be administered?
The Medical Oncology Program will be administered by AIM Specialty Health® (AIM) on behalf of your patients’ BCBSNC plan. Participating in the Program is most easily managed using the AIM ProviderPortal, available 24/7 accessed through Blue E https://providers.bcbsnc.com/providers/login.faces, or by calling AIM directly.

Who may participate in the Medical Oncology Program and may be eligible to receive enhanced reimbursement?
Only Participating Providers who are in-network for the member’s benefit plan are eligible to recieve enhanced reimbursement when selecting an AIM Cancer Treatment Pathway regimen.

Are all chemotherapy drugs, including supportive care drugs, managed through the Program?
Only Participating Providers who are in-network for a qualifying member’s benefit plan are eligible to receive enhanced reimbursement when selecting an AIM Cancer Treatment Pathway regimen.

Are all chemotherapy drugs, including supportive care drugs, managed through the Medical Oncology Program?
Providers may enter cancer treatment drugs, including supportive care drugs, into the AIM ProviderPortal through Blue E. The system will thereafter identify cancer treatment regimens that match the list of drugs which have been entered.

About AIM Cancer Treatment Pathways

What do you mean by AIM Cancer Treatment Pathway?
Pathways are widely accepted as a component in managing oncology treatment quality and costs. More specific than guidelines, pathways identify treatments selected based on effectiveness, favorable toxicity profiles, and cost. Over half of practices responding to ASCO’s 2010 National Practice Benchmark report that they regularly use pathways in patient care. Organizations that have implemented pathways have found that survival outcomes are equivalent for patients treated on and off pathway, while treatment costs decrease substantially for patients treated on pathway.

How were the AIM Cancer Treatment Pathways developed?
The goal of the Medical Oncology Program is to promote access to quality and affordable cancer care for health plan members. A key component of the Medical Oncology Program is the development of the AIM Cancer Treatment Pathways.

AIM Cancer Treatment Pathways are developed using a rigorous process of evidence-based medicine. In order to be considered as a possible Cancer Treatment Pathway, a cancer treatment regimen must first be recognized by national guidelines as an effective and recommended cancer therapy.

The Pathways are developed starting with the medical evidence and national clinical guidelines, such as NCCN and ASCO guidelines, which also are used for developing Anthem medical policy. The Pathways are then reviewed by an external Advisory committee that consist of geographically diverse physicians who are actively treating patients and work in academic and community oncology groups. The committee uses a process similar to how we evaluate drugs chosen for our drug formularies. The group evaluates the evidence for given treatments and compares outcomes for each – much like a comparative effectiveness review. Then, they compare costs of those regimens with the best outcomes.

How are AIM’s external advisors selected?
Our advisors are selected because of their clinical expertise in cancer care. Of the physicians currently serving as advisors for AIM, some are on the staffs of NCI or NCCN designated cancer centers, and some are in community practice settings; many serve or have served on national committees for organizations such as NQF, ASCO, FACT, and IOM to improve cancer care.

Does AIM have a process to manage conflicts of interest for external advisors?
AIM is committed to having clinical experts free of commercial bias and conflicts of interest determining which treatment regimens to be included in Pathways. Upon agreeing to serve as advisors, advisors must sign a formal Agreement that outlines the responsibilities; including an acknowledgment that advisor has no conflict of interest. Advisors also agree to notify AIM immediately of the existence of any conflict of interest. Additionally, advisors must sign a new conflict of interest attestation, at least once annually.

The AIM Cancer Treatment Pathways are selected on the basis of:

  • Clinical benefit (efficacy)
  • Side-effects (toxicity), especially those that lead to hospitalizations or impact quality of life
  • Strength of national guideline recommendations
  • Cost (final consideration when efficacy, toxicity, and national guidelines are equal)

Cost is considered only after consideration of all other factors in selecting a therapy as a Cancer Treatment Pathway.

The Cancer Care Quality Program may consider dosage and drug schedules (i.e. the interval between doses) in selection of a pathway regimen.

Where can I find a copy of the AIM Cancer Treatment Pathways?
The pathways are posted on www.medicaloncologyprogram.com. On this website you can find information, tools and worksheets to assist you in incorporating the Medical Oncology Program into your practice.

What should I consider when selecting a pathway?
Selecting a pathway depends upon a number of factors -the type of cancer, the stage of disease, and the biomarkers or specific genetic profile of the cancer. Within each cancer type, separate pathways are usually available for early stage and advanced cancer, sub-types of cancer (e.g. HER2 positive) and different lines of therapy.

What should I consider when selecting a pathway?
Selecting a pathway depends upon a number of factors -the type of cancer, the stage of disease, and the biomarkers or specific genetic profile of the cancer. Within each cancer type, separate pathways are usually available for early stage and advanced cancer, sub-types of cancer (e.g. HER2 positive) and different lines of therapy.

What if I am treating a patient for whom a Pathway regimen option is not available?
AIM Cancer Treatment Pathways include multiple regimens for different clinical situations. However, if a Pathway regimen is not available for a particular type of cancer or line of therapy, you can select a different regimen. Please note that enhanced reimbursement is only available for designated AIM Cancer Treatment Pathways.

Do Pathways apply to pediatric patients?
The Medical Oncology Program only applies to adult oncology patients at this time. However, you are encouraged to enter regimens for all malignancies into the AIM ProviderPortal.

What happens if I do not select a treatment regimen that is designated as an AIM Cancer Treatment Pathway?
We recognize that every patient is unique. While efforts have been made to identify Cancer Treatment Pathways that offer the best treatment option for most patients, you may decide that another treatment regimen is best for an individual patient. Whether a cancer treatment pathways or an alternate regimen is chosen, the Medical Oncology Program supports benefit coverage for all regimens that meet the clinical review criteria under BCBSNC medical policies and clinical guidelines. If you do not select a treatment regimen that is designated as a Cancer Treatment Pathway, you will not be eligible for the enhanced S-code reimbursement.

How often are the AIM Cancer Treatment Pathways updated?
AIM Cancer Treatment Pathways are reviewed at least quarterly or more frequently, as needed.

Are supportive drugs included in the Pathways?
Supportive care drugs, such as those used to manage side effects of chemotherapy, are not currently included in the AIM Cancer Treatment Pathways. However, the entire cancer treatment drug regimen, including supportive care drugs, should be included in the order request as certain supportive drugs may be included on the list of drugs that require utilization management review against applicable BCBSNC medical policies or clinical guidelines.

About pharmacy benefits programs

What should I do if the drugs I am ordering require prior authorization/precertification under my patients’ pharmacy benefits?
Please contact the patient’s Pharmacy Benefit Administrator for any necessary Pharmacy Plan authorizations or pre-certifications required.

About AIM Specialty Health and the clinical appropriateness review process

What is AIM Specialty Health and what is its role in the Medical Oncology Program?
The program will be administered by AIM Specialty Health on behalf of your patients’ health plans. AIM Specialty Health, a separate company, collaborates with payors to help improve healthcare quality and manage costs for some of today’s complex tests and treatments, promoting patient care that’s appropriate, safe, and affordable.

How do I participate in the Medical Oncology Program through AIM?
Participating in the Medical Oncology Program can be a straightforward process and is most easily managed using the AIM ProviderPortalSM accessed through Blue E. ProviderPortal allows you to open a new order, update an existing order and retrieve your order summary. As an online application, ProviderPortal is available 24/7. Your first step is to register your practice in ProviderPortal, if you are not already registered.

Online:
The Medical Oncology Program is accessed through the AIM ProviderPortal. Login through Blue E at https://providers.bcbsnc.com/providers/login.faces The AIM ProviderPortal is available twenty-four hours a day, seven days a week, processing requests in real-time. You will access the AIM ProviderPortal for Medical Oncology using the same method as you do today for high tech imaging authorization requests.

By phone:
Call AIM Specialty Health toll-free at the following phone numbers and times:

AIM Contact Center Information:

AIM Contact Center Phone AIM Contact Center Hours Monday - Friday
  866-455-8414   8:00 am - 4:00 pm (ET)

How do I use the AIM ProviderPortal to submit my cancer treatment?
Enter the AIM ProviderPortal through Blue E. Click on DIMS/Medical Oncology Review button. Look for the DIM/Medical Oncology review button. A step-by-step tutorial on using the AIM ProviderPortal to submit your regimen can be accessed online by going to www.medicaloncologyprogram.com. If accessing AIM for the first time, registration will be required.

Once I have submitted a request, how long will it take to receive a response from AIM?
Requests that meet criteria receive a response instantly on screen in the AIM ProviderPortal or on the phone with the AIM contact center.

If I am an in-network provider for the member’s benefit plan and I select an AIM Cancer Treatment Pathway, how will I be notified of the enhanced reimbursement?
When selecting an AIM Cancer Treatment Pathway regimen, you must use either the AIM ProviderPortal or phone. In both instances, you will be notified immediately after selecting a Pathway regimen that you are eligible for S-code reimbursement (LINK). A separate letter will not be provided. It is recommended that you save the summary page that you receive from the AIM ProviderPortal after completing your initial order in your patients’ chart.

What happens if I do not call AIM or enter information through the AIM ProviderPortal?
If you call BCBSNC directly, you will be directed to use the AIM ProviderPortal or call the AIM contact center. If you do not provide AIM with the necessary information, you will not be eligible for enhanced reimbursement, even if the treatment regimen is on Pathway. In addition, if any oncology drugs are subject to health plan Medical Policy or Clinical Guidelines and have not been reviewed prospectively, they may be subject to post-service review and payment may be denied.

What if I need a longer treatment period than is indicated in the Cancer Treatment Pathway?
The AIM Cancer Treatment Pathway reflects an expected duration of treatment. For a regimen (e.g., adjuvant therapy) of fixed duration, the Pathway enhanced reimbursement is for the duration of all planned cycles of chemotherapy. For a treatment regimen that is indefinite (e.g., planned until disease progression), the Pathway enhanced reimbursement is for 6 months. If treatment continues beyond 6 months, please submit a new treatment regimen request to AIM. Most users will find the most efficient way to track the Pathway time period is to save the summary page that you receive from the AIM ProviderPortal after completing your initial order in your patients’ charts so that the information to report continuation of treatment is easily available.


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