UPDATE: New Rehabilitative Program now effective August 1, 2019
Anthem Blue Cross (Anthem) previously communicated in the April 2019 edition of Anthem’s Provider News that AIM Specialty Health® (AIM), a separate company, would begin to perform prior authorization review of rehabilitative (restoring function) and habilitative (enhancing function) services for Anthem fully insured members beginning May 1, 2019. Due to recent group membership, provider status, and system issues experienced by Anthem and AIM, the program will now be implemented on August 1, 2019. Through July 31st, for requests in progress and for new requests, coverage for PT/ST/OT visits will not require a prior authorization.
AIM will manage Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) medical necessity reviews and will require prior authorization for all outpatient facility and office-based rehabilitative and habilitative services following the initial evaluation. AIM will use the following Anthem Clinical UM Guidelines:
- CG-REHAB-04 Physical Therapy
- CG-REHAB-05 Occupational Therapy
- CG-REHAB-06 Speech-Language Pathology Services
The clinical criteria to be used for these reviews can be found on the anthem.com/ca Clinical UM Guidelines page. A complete list of CPT codes requiring prior authorization for the AIM Rehabilitative Program is available on the AIM Rehabilitation microsite. There you can access additional helpful information such as order entry checklists and FAQs.
AIM will now begin accepting prior authorization requests on July 17, 2019 for dates of service on and after August 1, 2019. Ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortallSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
- Access AIM via the Availity Web Portal at availity.com.
- Call the AIM Contact Center toll-free number at 1-877-291-0360, Monday – Friday, 7:00 a.m. – 5:00 p.m., PT.
Anthem invites you to take advantage of an informational webinar that will introduce you to the Rehabilitative Program and the robust capabilities of the AIM ProviderPortalSM. Visit the AIM Rehabilitation microsite to register for an upcoming training session.
July UPDATE: New Rehabilitative Program Now Effective August 1, 2019 – California