Reminder: site of service reviews required for outpatient physical, occupational and speech therapy effective August 1, 2021
As previously communicated in the May and July 2021 editions of Provider News, AIM Specialty Health® (AIM) expanded the AIM Rehabilitative Program to perform medical necessity reviews of the requested site of service for physical, occupational and speech therapy procedures for Anthem commercial, fully-insured members.
As of August 1, 2021, as part of the AIM Rehabilitative Site of Care Program, AIM requires prior authorization for all outpatient facility and office-based rehabilitative and habilitative services. Although an authorization for the initial evaluation is not required for Anthem Commercial members, providers may submit an evaluation request prior to starting the episode of care. The initial evaluation will be authorized along with any main treatment codes performed that day and the provider will be alerted of the site of care program on subsequent treatment requests to 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. This includes post service review which may result in a not medically necessary denial of coverage for the site of care. Requests that are deemed not medically necessary at a hospital site per Anthem Clinical UM Guideline: CG-REHAB-10 Site of Care: Outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services, may be approved for coverage in another site of care. 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 third birthday.
Prior authorization requests may be submitted via the AIM ProviderPortal or by calling 866-714-1107, Monday through Friday, 8:00 a.m. to 5:00 p.m.
The program may increase the number of new patient referrals to independent providers. Please contact your Provider Solutions Representative with any questions.
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. We also invite 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 the upcoming webinar on September 21 at 3:00 p.m. 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.
September 2021 New Hampshire Provider News