Updates to AIM Sleep Disorder Management clinical appropriateness guideline

This communication applies to the Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).

 

Effective for dates of service on and after August 16, 2020, the following updates will apply to the AIM Specialty Health_®* (AIM) Sleep Disorder Management Clinical Appropriateness Guideline.

 

Sleep Disorder Management Clinical Appropriateness Guideline updates by section:

• Bi-Level Positive Airway Pressure (BPAP) Devices:
  • Change in BPAP FiO2 from 45 to 52 mmHg based on strong evidence and alignment with Medicare requirements for use of BPAP
• Multiple Sleep Latency Testing and/or Maintenance of Wakefulness Testing:
  • Style change for clarity
  • Code changes: none 

 

As a reminder, ordering and servicing providers may submit prior authorization (PA) requests to AIM by:

 

• Accessing AIM’s ProviderPortal_SM directly at com. Online access is available 24/7 to process orders in real time, and is the fastest and most convenient way to request PA.
• Accessing AIM via the Availity Portal.*
• Calling the AIM Contact Center at 1-800-714-0040 from 5 a.m. to 5 p.m. PT.

 

What if I need assistance?

If you have questions related to AIM guidelines, email AIM at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

 

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