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Muskoskeletal Program

Horizon BCBSNJ is working with AIM Specialty Health® (AIM), a specialty benefits management company, to offer a Musculoskeletal Program to certain self-insured employer group health plans administered by Horizon BCBSNJ that engages health care professionals in the management of the complexities associated with musculoskeletal and interventional pain management services.

The AIM 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’s evidence-based clinical criteria and guidelines.

AIM performs reviews of certain surgeries of the spine and joints, as well as interventional pain management for Horizon BCBSNJ members. AIM conducts prior authorization and/or medical necessity determination (PA/MND) reviews of certain musculoskeletal pain management and spine surgery services to improve health care quality and manage health care costs, helping to promote care that is appropriate, safe and affordable.

Doctors and other health care professionals who order outpatient musculoskeletal services for their patients must call AIM prior to such services being rendered. This allows the AIM 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 the AIM 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.

Pre-service review requirements

All providers must contact AIM to obtain pre-service review for the following non-emergency modalities:

Joint surgery (Outpatient Place of Service Only)

  • Hip arthroscopy
  • Knee arthroscopy
  • Meniscal allograft transplantation
  • Shoulder arthroscopy
  • Total hip replacement
  • Total knee replacement
  • Total shoulder replacement
  • Treatment of osteochondral defects

Interventional pain management

  • Epidural steroid injections
  • Paravertebral facet joint injection/Nerve block/Neurolysis
  • Regional sympathetic nerve block
  • Sacroiliac steroid injections
  • Spinal cord stimulators

Surgeries and pain treatments performed as part of an inpatient admission are excluded.

How to place a review request:

To submit a request, register or login at aimspecialtyhealth.com/goweb. Providers may also call AIM Specialty Health at 1-866-766-0250, then press 1, Monday through Friday, from 9 a.m. to 6 p.m., Eastern Time (ET). This number is also displayed on the back of the member's ID card.

For more information:

Helpful information, order entry worksheets and FAQs is available by visiting aimproviders.com/msk/Resources.html.

For general information about AIM Specialty Health, call 1-847-564-8500, Monday through Friday, from 9 a.m. to 6 p.m., Eastern Time (ET).

We value your participation in our network and look forward to working with you to help improve the health of our members.

AIM Specialty Health® is a registered trademark of American Imaging Management, Inc.

American Imaging Management, Inc. supports Horizon Blue Cross Blue Shield of New Jersey in the administration of specialty benefits management. American Imaging Management, Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.