Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

AIM Specialty Health_® (AIM) currently performs utilization management review for bilevel positive airway pressure (BiPAP) equipment and all associated supplies. Beginning July 1, 2020, the following codes will require prior authorization with Anthem Blue Cross and Blue Shield (Anthem) rather than with AIM.

 

Line of business:  Individual Medicare Advantage, Group Retiree Solutions, and Medicare-Medicaid Plans

E0470	Respiratory assist device, bilevel pressure capability, without back-up rate feature, used with noninvasive interface, such as a nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0471	Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, such as a nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

AIM will continue to manage the supply codes for automatic positive airway pressure (APAP) and continuous positive airway pressure (CPAP) requests.

 

Anthem will continue to follow the COVID-19 Public Health Emergency orders from CMS until the waivers no longer apply.  If the Public Health Emergency Orders are no longer in place beginning July 1, 2020, the following codes will require prior authorization with Anthem rather than with AIM when used in combination with the BiPAP codes above.

 

Precertification requests

Submit precertification requests via:

• Fax: 1-866-959-1537
• Phone: Please dial the customer service number on the back of the member’s card, identify yourself as a provider and follow the prompts to reach the correct precertification team. There are multiple prompts. Select the prompt that fits the description for the authorization you plan to request
• Web: Use the Availity Web Tool by following this link: https://apps.availity.com/availity/web/public.elegant.login

 

AIM Specialty Health® is an independent company providing utilization management services on behalf of Anthem Blue Cross and Blue Shield.

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