Anthem Blue Cross and Blue Shield (Anthem) previously communicated on April 1, 2019 that AIM Specialty Health® (AIM), a separate company, would begin to perform prior authorization review of rehabilitative (restoring function) and habilitative (enhancing function) services for Anthem fully insured members beginning July 1, 2019. Due to recent group membership, provider status, and system issues experienced by Anthem and AIM, the program will now be implemented on August 1, 2019.  Effective until July 31st, for requests in progress and for new requests, coverage for Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) visits will not require a prior authorization.

 

AIM will manage PT, OT and ST medical necessity reviews and will require pre-certification for all outpatient facility and office-based rehabilitative and habilitative services following the initial evaluation.  AIM will use the following Anthem Clinical UM Guidelines:

 

The clinical criteria to be used for these reviews can be found online at anthem.com Clinical UM Guidelines page.  Please note, this does not apply to procedures performed in an inpatient or observation setting, or on an emergent basis, services with diagnosis of autism, and the initial evaluation.

 

A complete list of CPT codes requiring pre-certification for the AIM Rehabilitation 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 pre-certification requests on July 17, 2019 for dates of service on and after August 1, 2019.  Ordering and servicing providers may begin contacting AIM beginning June 17 for review.  Providers may submit pre-certification 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: 877-291-0366, Monday–Friday, 7:00 a.m.-5:00 p.m. PT.

 

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.

 



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UPDATE: new Rehabilitative Program now effective August 1, 2019 - Nevada