Musculoskeletal Program

The Musculoskeletal Program covers services in the outpatient setting, using evidence based clinical guidelines to help reduce inappropriate care, overtreatment, and excessive costs while helping to ensure safe and effective care.

The program offers a prospective review of certain services to promote improved quality of care for all plan beneficiaries and to assess whether the proposed services are medically necessary and appropriate when evaluated against AIM Specialty Health’s evidence-based clinical criteria and guidelines.

To maximize the benefits achieved by this program, doctors and other health care professionals ordering outpatient musculoskeletal services for their patients must call AIM prior to such services being rendered to allow AIM’s prospective review to occur and for the doctors and other health care professionals to receive the qualitative feedback afforded by these AIM quality improvement programs.

If the planned services do not meet AIM’s guidelines for medical necessity, AIM may suggest that the doctor or other health care professional consider offering an alternative service or withdraw the requested service entirely.