Completion of this form is solely for the purposes of initiating a precertification request. Completion of the form does not mean that precertification has been completed. Please initial the following acknowledgement in order to proceed with submitting your initiation of a precertification request:

I hereby acknowledge that by completing the following process I am simply initiating a precertification request. I understand that completion of this form does not mean that the requested service has been precertified by AIMM. I understand that my completion of this form does not have any bearing on the coverage by the health plan for the requested service. I understand that the precertification process is not completed until I have received a certification decision and reference number from an AIMM RN. I understand that neither completion of this form nor obtaining precertification is a guarantee of benefits, eligibility, payment, nor is it a medical treatment decision or advice.

I also acknowledge that I have read and understand the full Terms of Use for our On-Line Precertification Program.

Initials:*

PLEASE NOTE: AIMM does NOT accept fax review. Provide all pertinent clinical here OR call and provide clinical verbally.



Truly emergent medical treatment should never be withheld in order to complete precertification (which is only one component of the health plan's coverage determination). Anytime that the health of the patient would be placed in serious jeopardy, serious impairment of bodily functions, or a serious dysfunction of a body organ or part could result from a delay in care, then care would be considered truly emergent. The medical professionals rendering care to patients are solely responsible for ensuring that care is delivered in accordance with patient needs and should never make treatment decisions, especially in truly emergent situations, based on payment related (such as precertification) issues. Please be aware that precertification is not a guarantee of benefits, eligibilty, payment, nor is it a medical treatment decision or advice.


Here at AIMM, we are committed to the ideals of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). We’ve taken steps to preserve the privacy and security of individually identifiable patient information transmitted via the PreCert platform.

Here are some security and privacy safeguards that we have implemented to ensure that our PreCert program is HIPAA compliant:

  • Firewall – AIMM’s firewall prevents unauthorized parties and traffic from accessing the platform.
  • Encryption – The strongest encryption technology available protects data during transmission.
  • Session timeout – The automatic log-out function protects inadvertent access if a workstation is left unattended.
  • Physical security – Our data center is protected by continuous key-card entry, video surveillance, security breach alarms and 24/7 on-premises Security Officers.
Questions? Contact us at (866) 845-8854.

Completion of this form is solely for the purposes of initiating a precertification request. Completion of the form does not mean that precertification has been completed. All users are required to read our Terms of Use and acknowledge the initiation of the precertification request.

Contact us to get more help or information.




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