AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates

Effective for dates of service on and after June 12, 2022, the following updates will apply to the AIM Specialty Health_® (AIM)* Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates focus on advancing efforts to drive clinically appropriate, safe, and affordable healthcare services.

 

Physical therapy and occupational therapy:

• Removed definition of evidence-based therapy and added definition for functional progress
• Added examples of the following:
  • Appropriate goals
  • Skilled intervention documentation
  • Clinically meaningful improvement and functional progress
  • Rehabilitation purpose

 

Speech-language pathology:

• Removed definition of evidence-based therapy and added definition for functional progress
• Added examples of the following:
  • Appropriate goals
  • Functional progress
  • Rehabilitation purpose

 

Physical therapy and occupational therapy adjunctive treatments:

• Removed dry needling indication
• Edited exclusions

 

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of the following methods:

• Access AIM’s ProviderPortal_SM 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* Portal at availity.com.
• Call the AIM Contact Center toll-free number at 866-714-1107, Monday–Friday, 8 a.m.–5 p.m.

 

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

 

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem. Availity, LLC is an independent company providing administrative support services on behalf of Anthem.

 

422-0322-PN-CTNH