UPDATE: New AIM Rehabilitative Program effective April 1, 2020

Anthem Blue Cross and Blue Shield (Anthem) announced in July that the AIM Rehabilitative Program was delayed.  This message is sent to announce that the AIM Rehabilitative program for Anthem’s Commercial Membership will relaunch April 1, 2020.  AIM Specialty Health® (AIM), a separate company, will perform prior authorization review of physical, occupational and speech therapy services.  Requests may be submitted beginning March 16, 2020 via the AIM ProviderPortal for dates of service April 1st and after.  The OrthoNet program is no longer active in applicable markets. Processes have been put in place to allow providers to continue to provide treatment and allow claims to process.  Claims that were denied for no authorization in error after 7/1 will reprocess. 

 

The AIM Rehab Program follows the Anthem Clinical Guidelines that state the services must be delivered by a qualified provider of therapy services acting within the scope of their licensure. Qualified providers acting within the scope of their license, including chiropractors, who intend to provide PT, OT or ST services should request prior authorization for those services through AIM. 

 

Please note that if you are providing PT/OT/ST services to an Anthem Commercial member whose state of issuance is part of the AIM Rehab Program, you will be required to obtain an authorization.

 

NEW CHANGES TO AIM’S REHAB PROGRAM

 

This is to inform you that Anthem and AIM Specialty Health are working together to make improvements to the clinical review of PT/OT/ST Services when used to treat Autism Spectrum Disorder or Pervasive Developmental Delays as defined by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.  Currently, prior authorization is not required for PT, OT, or ST out-patient therapy services when receiving skilled treatment for Autism Spectrum Disorder or Pervasive Developmental Delays for members with Anthem commercial plan. You may file your claims without a prior authorization number if you are billing with one of the following ICD-10 codes: F84.0, F84.2, F84.3, F84.5, F84.8, or F84.9. Please note that benefit limits, if applicable, will still be applied.  We will let you know when the AIM Rehab Program for Autism Spectrum Disorder or Pervasive Developmental Delay program is scheduled for implementation. 

 

Anthem is also transitioning vendors for review of Rehabilitative Services for our *Medicare members to include out-patient PT, OT, and SLP, to AIM Specialty Health.  The AIM Rehab program will now begin in April 2020.  Prior authorization will not be required for the above mentioned services through March 2020.  *This does not apply to members in the states of FL, NJ and NY for whom prior authorization will still be required. Please review the update in an upcoming notice for more information about the AIM Rehabilitative Program for Medicare members.