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 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* 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.


+The applicable policy is attached to this article in PDF format.

 

422-0322-PN-ME



Featured In:
March 2022 Anthem Maine Provider News