Effective July 1, 2019, Anthem Blue Cross and Blue Shield (Anthem) will transition medical necessity review of rehabilitative (restoring function) and habilitative (enhancing function) services for fully insured members to AIM Specialty Health® (AIM). Currently, OrthoNet LLC is performing medical necessity reviews for physical and occupational therapy services for Anthem. These reviews will transition to AIM in addition to adding speech therapy service reviews.

 

AIM will manage Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) medical necessity reviews using the following Anthem Clinical Utilization Management (UM) Guidelines:

  • CG-REHAB-04 Physical Therapy
  • CG-REHAB-05 Occupational Therapy
  • CG-REHAB-06 Speech-Language Pathology Services.

 

Please note, this does not apply to procedures performed in an inpatient or observation setting, or on an emergent basis. The clinical criteria to be used for these reviews can be found on the Anthem Provider website on the Clinical UM Guidelines webpage. A complete list of CPT codes requiring prior authorization for the AIM Rehabilitative program is available on the AIM Rehabilitation microsite. There you can learn more about the program and access helpful information and tools such as order entry checklists and FAQs.

 

AIM will begin accepting prior authorization requests on June 17, 2019 for dates of service on and after July 1, 2019. To determine if prior authorization review is needed for an Anthem member, please check online or call the pre-service review number located on the back of the member ID card. As of July 1, 2019, self-funded accounts (ASO) that currently have the OrthoNet program will also be offered the AIM Rehabilitative program. The program will also be offered to new local self-funded accounts (ASO) to add to their members’ benefit package as of July 1, 2019.

 

Ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

  • Access AIM’s ProviderPortalSM 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 Web Portal at availity.com
  • Call the AIM Contact Center toll-free number at (800) 554-0580, Monday through Friday, 8:30 a.m. to 7:00 p.m. ET.

 

AIM Rehabilitation training webinars

Anthem invites you to take advantage of a free informational webinar that will introduce you to the program and the robust capabilities of the AIM ProviderPortalSM.  Go to the AIM Rehabilitation microsite to register for an upcoming webinar. If you have previously registered for other services managed by AIM, there is no need to register again. The training will be recorded and can be viewed at a time convenient for you! 



Featured In:
April 2019 Anthem Provider Newsletter - Kentucky