As previously communicated in the May 2021 edition of Provider News, effective August 1, 2021, AIM Specialty Health® (AIM), a separate company, will expand the AIM Rehabilitative program to perform medical necessity reviews of the requested site of service for physical, occupational and speech therapy procedures for Anthem Blue Cross and Blue Shield (Anthem) fully insured members.

 

AIM will require prior authorization for all outpatient facility and office-based rehabilitative and habilitative services. Prior authorization is recommended for the initial evaluation service codes, unless otherwise prohibited, to alert the provider of the site of care program and ensure the member is receiving care at the appropriate site of service early in the process. After the evaluation, ongoing services will be subject to site of care review and require prior authorization, including post service review which may result in a denial of coverage as not medically necessary for the site of care. Requests that are not medically necessary at a hospital site may be approved for coverage at a free standing or office-based setting.

 

AIM will use the following Anthem Clinical UM Guidelines: CG-REHAB-10 Site of Care: Outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services. The clinical criteria to be used for these reviews can be found on the Anthem Provider portal Clinical UM Guidelines page. Please note, this does not apply to procedures performed in an inpatient or observation setting, or on an emergent basis, members currently in an episode of care at the start of the program, services with diagnosis of autism, and members ages birth to 3rd birthday.

 

AIM will begin accepting prior authorization requests on July 19, 2021 for services provided on or after August 1, 2021. Prior authorization requests may be submitted via the AIM’s ProviderPortalSM directly at providerportal.com or by calling 800-554-0580, Monday through Friday, 8:30 a.m. to 7:00 p.m. ET.

 

AIM rehabilitation educational information

The AIM provider portal helps you learn more and access helpful information and tools such as order entry checklists and CPT code lists. Anthem also 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 access helpful information and register for an upcoming webinar on July 8 or July 27 at 3 p.m. ET. If you have previously registered for other services managed by AIM, there is no need to register again.

 

We value your participation in our network and look forward to working with you to help improve the health of our members.

 

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Featured In:
July 2021 Anthem Provider News - Missouri