Reminder and update: new Rehabilitative Program effective July 1, 2019

As previously communicated in the April 2019 edition of Provider News, AIM Specialty Health® (AIM), a separate company, will begin to perform pre-service clinical review of rehabilitative (restoring function) and habilitative (enhancing function) services for Anthem commercial fully insured members beginning July 1, 2019. Currently, OrthoNet LLC is performing medical necessity reviews for physical and occupational therapy services for Anthem. These reviews, in addition to speech therapy service reviews, will transition to AIM.

 

AIM will manage physical therapy (PT), occupational therapy (OT) and speech therapy (ST) medical necessity reviews and will require pre-service clinical review 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 used for these reviews can be found on our anthem.com Clinical UM Guidelines page. A complete list of CPT codes requiring pre-service clinical review 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 pre-service clinical review requests on June 24, 2019 for dates of service on and after July 1, 2019.  Ordering and servicing providers may submit pre-service clinical review requests to AIM in one of several ways:

 

• 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 clinical review.
• Access AIM via the Availity Web Portal at availity.com.
• Call the AIM Contact Center toll-free number – 866-714-1107, Monday–Friday, 8:00 a.m.–5:00 p.m.

                                                                                               

Need training?

We invite you to take advantage of an informational webinar that will introduce you to the Rehabilitative Program and the robust capabilities of the AIM ProviderPortal_SM.  Visit the AIM Rehab microsite to register for an upcoming training session.