REMINDER: New AIM Rehabilitative Program effective November 1, 2019

As previously communicated in the October 2019 edition of Anthem Blue Cross and Blue Shield’s ("Anthem") Provider News, the AIM Rehabilitative program for commercial membership relaunched November 1st. AIM Specialty Health® (AIM), a separate company, will perform prior authorization review of physical, occupational and speech therapy services. Requests may be submitted via the AIM ProviderPortal for dates of service 11/1 and after. The OrthoNet program is no longer active in applicable markets.

 

Due to the current American Specialty Health (ASH) chiropractor utilization management program in Georgia, chiropractors will continue to be managed by ASH including requests for review of certain codes that may also be part of the AIM Rehab program. Chiropractors in Georgia will not be required to obtain an authorization from AIM.

 

New changes to AIM’s Rehab Program

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. 

 

Effective 11/1/2019 in the state of Georgia, preauthorization 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 plans. You may file your claims without a preauthorization 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.

 

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. Anthem has decided to delay the implementation of this transition. The AIM Rehab program will now begin in April 2020. Prior authorization will not be required for the above mentioned services through March 2020.  

 

Please be sure to check upcoming editions of Provider News for more information about the AIM Rehabilitative Program for Medicare members.