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Medical Policy and Coding Updates - February 2022
Premera Blue Cross·WA · Radiology, Oncology, Cardiology +9 more·Medical Policy
Effective date
Mar 13, 2022
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated AIM Specialty Health clinical guidelines for advanced imaging, radiation oncology, and multiple drug policies effective February-March 2022. Changes include revised criteria for imaging studies, new prior authorization requirements for specialty drugs, and updated medical necessity criteria for various treatments.
Action Required
By March 13, 2022: Billing team must update prior authorization processes for AIM Specialty Health imaging guidelines including new criteria for brain, chest, abdominal, pelvic, and cardiac imaging. Update encounter forms to reflect new requirements for ultrasound before MRI for uterine fibroids and revised follow-up criteria for pulmonary nodules. Review all specialty drug prior authorizations for newly added site-of-service requirements and updated medical necessity criteria. Failure to follow new guidelines will result in claim denials.