As we communicated in the October 2019 edition of Provider News, the AIM Rehabilitative program for Anthem’s commercial membership relaunched on November 1.  AIM Specialty Health® (AIM), a separate company, is performing prior authorization review of physical (PT), occupational (OT) and speech (ST) therapy services.  Prior authorization requests can be submitted via the AIM ProviderPortalSM.  The OrthoNet program is no longer active in applicable markets.


The AIM Rehab Program follows the Anthem Clinical Guideline (CG-Rehab-04) that states the skilled services must be delivered by a licensed physical therapist or other qualified licensed health care professional. Qualified providers acting within the scope of their license, including chiropractors, who intend to provide the CPT codes for PT, OT or ST services referenced in this Clinical Guideline should request prior authorization (where permitted by law)  for those services through AIM. 


In addition, in November we announced the delay of the transition of vendors for review of outpatient PT, OT and ST rehabilitative services for our Medicare members to AIM Specialty Health. The AIM Rehabilitative program for Medicare members will now begin in April 2020; prior authorization will not be required for Medicare members for PT, OT and ST services through March 2020.  (Note: This delay does not apply to members for whom prior authorization will still be required.)


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


Upcoming changes to AIM’s Rehabilitative Program

Anthem and AIM Specialty Health are working together to make improvements to the clinical review of PT, OT and 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. 


We are working to adjust our claims systems to not look for an authorization for commercial members who are receiving skilled treatment for autism spectrum disorder or pervasive developmental delays with one of the following ICD-10 diagnoses: F84.0, F84.2, F84.3, F84.5, F84.8, or F84.9. Until that time, AIM will continue to issue authorizations for PT, OT, and ST services for those diagnoses to help ensure claims are paid appropriately. We will update you once we confirm the effective date of the removal of the prior authorization requirement in our claim system. Please note that while AIM may issue an authorization, benefit limits, if applicable, will still be applied.

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December 2019 Anthem Maine Provider News