REMINDER: New AIM Rehabilitative Program effective November 1, 2019

As previously communicated in the October 2019 edition of Empire BlueCross BlueShield’s (“Empire”) Provider News, the AIM Rehabilitative program for Empire’s commercial membership relaunched November 1st.  AIM Specialty Health® (AIM), a separate company, will perform prior authorization review of physical, occupational and speech therapy services.  Requests may be submitted via the AIM ProviderPortal for dates of service 11/1 and after. The OrthoNet program is no longer active in applicable markets.

 

Due to the current ASH Chiropractor utilization management program in New York, Chiropractors will continue to be managed by ASH including requests for review of  certain codes that may  also be part of the AIM Rehab program.  Chiropractors in New York  will not be required to obtain an authorization from AIM.

 

Also communicated in October, Empire is transitioning vendors for review of Rehabilitative Services for our *Medicare members to include outpatient PT, OT, and ST to AIM Specialty Health.  Empire has decided to delay the implementation of this transition. The AIM Rehab program for Medicare members will now begin in April 2020.  Prior authorization will not be required for the above mentioned services through March 2020.  

 

*This 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.

 

New changes to AIM’s Rehab Program

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

 

Empire is 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 configuration in our claim system. Please note that while AIM may issue an authorization, benefit limits, if applicable, will still be applied.

Note: For Empire Medicaid members, there are no changes to the existing program.