Transition of Outpatient Rehabilitation Utilization Management program

Effective March 1, 2019, Empire BlueCross BlueShield HealthPlus (Empire) will transition its Outpatient Rehabilitation Utilization Management (UM) program to AIM Specialty Health® (AIM), a specialty health benefits company. The Outpatient Rehabilitation UM program includes physical, occupational and speech therapy services.

 

Empire has an existing relationship with AIM in the administration of other programs and is excited to expand this relationship to include outpatient rehabilitation services. AIM works with leading insurers to improve health care quality and manage costs for today’s most complex and prevalent tests and treatments, helping to promote care that is appropriate, safe and affordable.

 

This transition enables Empire to expand and optimize this program, further ensuring that care aligns with established evidence-based medicine. AIM will continue to use criteria documented in Empire Clinical UM Guidelines GC.REHAB.04, CG.REHAB.05 and CG.REHAB.06 for review of these services. These clinical guidelines can be reviewed online at https://www.availity.com by selecting Clinical Resources in the Education and Reference Center under Payer Spaces.

 

Detailed prior authorization requirements are available online by accessing the Precertification Lookup Tool at https://www.availity.com under Payer Spaces. Contracted and noncontracted providers can call Provider Services at 1-800-450-8753 for prior authorization requirements or additional questions.

 

You can also authorize these services online through the Interactive Care Reviewer on the Availity Portal. Log on to Availity, select Authorizations and Referrals under the Patient Registration menu and choose Authorizations.

 

Pre-service review requirements

Providers should contact Empire to obtain prior authorization for all outpatient rehabilitation services that are scheduled to be rendered through February 28, 2019. Any authorizations Empire makes prior to the transition date of March 1, 2019, will be honored, and claims will process accordingly.

 

Providers should contact AIM to obtain prior authorization for all services scheduled on or after March 1, 2019. Beginning February 11, 2019, providers will be able to contact AIM for prior authorization on services scheduled to take place on or after March 1, 2019. Providers are strongly encouraged to verify prior authorization has been obtained before scheduling and performing services.

 

How to place a review request

Providers can submit prior authorization requests to AIM in one of the following ways:

• Access AIM ProviderPortalSM directly at https://www.providerportal.com. You will first need to register for this portal at http://aimspecialtyhealth.com/goweb.html. Online access is available 24/7 to process orders in real time and is the fastest and most convenient way to request authorization. Registration opens February 11, 2019.
• Access AIM via the Availity Portal at https://www.availity.com. For any questions, call the AIM Contact Center toll-free number at 1-800-554-0580 Monday through Friday from 8 a.m. to 8 p.m. Eastern time.

 

For more information

For resources to help get started with the Outpatient Rehabilitation UM program, go to www.aimprovider.com/rehabilitation. The AIM provider website provides access to useful information and tools, such as order entry checklists, Clinical UM Guidelines and an FAQ.

 

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

 

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 1-800-450-8753.