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Arkansas BlueCross BlueShield: AIM Medical Oncology Program to be Implemented for Tyson Foods Enrollees

Effective January 1, 2018, Tyson Foods will implement review of outpatient radiation oncology services and medical oncology treatment regimens for its employee health plan. These programs will be managed by AIM Specialty Health (AIM). AIM works with leading insurers and employers to improve health care quality and manage costs for today’s most complex and prevalent tests and treatments, helping to promote care that is appropriate, safe and affordable. Tyson Foods members may be identified by the TYG prefix on their member identification cards.

Medical Oncology Program
The AIM Medical Oncology Program promotes optimal support for our members’ cancer care needs, while reducing the costs for managing one of the most complex, expensive and prevalent diseases they can encounter. This program includes online access to support tools for selecting cancer treatment regimens, consistent with current evidence and consensus guidelines for oncologists and hematologists. The program includes AIM Cancer Treatment Pathways (Pathways) based on medical evidence and best practices developed with leading cancer experts. AIM Cancer Treatment Pathways offer support in identifying highly effective therapies that are often more affordable for our members. More specific than guidelines, they identify treatments based on clinical efficacy, favorable toxicity profiles and cost. Pathway regimens in this program are informed by a clinical library and include evidence drawn from:

  • Peer-reviewed published literature
  • Expert consensus statements and guidelines from professional organizations, including:
    1. American Society of Clinical Oncology (ASCO)
    2. American Society of Hematology (ASH)
    3. National Comprehensive Cancer Network (NCCN)
  • Federal government agencies, including:
    1. Food and Drug Administration (FDA)
    2. National Cancer Institute (NCI)

Program Administration
The program, administered by AIM Specialty Health, will help improve cancer care quality for eligible Tyson Foods members, and manage the associated costs for certain complex tests and treatments by promoting patient care that’s appropriate, safe and affordable.

Radiation Oncology Review Program
This program reviews certain treatment plans against clinical appropriateness criteria to help ensure that care aligns with established evidence based medicine. To request review, providers should contact AIM for pre-service review for the radiation oncology modalities and services.

Pre-certification
For treatment plans that are scheduled to begin on or after January 1, 2018, all providers must contact AIM to obtain pre-service review for the following non-emergency, outpatient radiation oncology modalities:

  • 2D/3D conformational radiation therapy
  • Intensity-modulated radiation therapy
  • Stereotactic radiosurgery
  • Stereotactic body radiotherapy
  • Selective internal radiation therapy
  • Brachytherapy
  • Proton beam therapy

Review also included for:

  • Hypo fractionation for bone metastases, non-small cell lung cancer and breast cancer when requesting EBRT and IMRT
  • Special procedures and consultations associated with a treatment plan (CPT codes 77370 and 77470)
  • Image Guided Radiation Therapy (IGRT) Radiation oncology performed as part of an inpatient admission is not part of the AIM program.

Questions
If you have questions, please speak with a Arkansas Blue Cross provider service representative by calling the BlueCard Eligibility line at 1-800-676-BLUE (2583). If the Arkansas Blue Cross member’s ID card does not include an alpha prefix, please call the provider service phone number on the ID card.

Published on: November 22, 2017, 01:35 a.m. ET
Last updated on: November 23, 2017, 01:42 a.m. ET