MedicaidJanuary 31, 2021
Updated AIM Rehabilitative program effective August 1, 2021 - Initial evaluations and site of care reviews
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
Effective August 1, 2021, AIM Specialty Health® (AIM),* a separate company, will expand the AIM Rehabilitative program to perform medical necessity review evaluations for physical, occupational and speech therapy procedures and the requested site of care for Empire BlueCross Blue Shield HealthPlus (Empire) fully insured members, as further outlined below.
AIM will continue to manage physical therapy (PT), occupational therapy (OT) and speech therapy (ST) medical necessity reviews and will require prior authorization for all outpatient facility and office-based rehabilitative and habilitative services. Prior authorization will now also be required for the initial evaluation and the requested site of care. AIM will use the following Empire Clinical UM Guidelines: CG.REHAB.10 Level of care: outpatient physical therapy, occupational therapy and speech-language pathology services. This clinical guideline can be reviewed online at https://www.availity.com by selecting Clinical Resources in the Education and Reference Center under Payer Spaces. 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, or the initial evaluation.
A complete list of CPT® codes requiring prior authorization for the AIM Rehabilitation program is available on the AIM Rehabilitation microsite. To determine if prior authorization is needed for an Empire member on or after August 1, 2021, providers can contact Provider Services at 1-800-450-8753 for benefit information. They will be informed whether the AIM Rehabilitation program applies. AIM will also have a file upload from the health plan of the in-scope membership and will not provide pre-certification for members who are out of scope. If providers use the interactive care reviewer (ICR) tool on the Availity Portal* to pre-certify an outpatient rehabilitative or habilitative service, ICR will produce a message referring the provider to AIM. (Note: ICR cannot accept prior authorization requests.)
AIM will be accepting authorizations on July 19, 2021, for services performed on or after August 1, 2021.
How to place a review request
Providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortallSM directly at http://www.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 https://www.availity.com.
- Call the AIM Contact Center toll-free number at 1-800-714-0040 from 7 a.m. to 7 p.m. ET.
Initiating a request on AIM’s ProviderPortalSM for PT/OT/ST and entering all the requested clinical questions will allow you to receive an immediate determination. If the request is approved, you will receive the order ID, the number of visits and valid time frame. The AIM Rehabilitation Program microsite on the AIM provider portal helps you learn more and access helpful information and tools such as order entry checklists.
AIM Rehabilitation training webinars:
Empire 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.
We value your participation in our network and look forward to working with you to help improve the health of our members.
PUBLICATIONS: February 2021 Empire Provider News
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