New Rehabilitation program effective August 1, 2022

At Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc., we’re always looking for ways to create value for all our stakeholders. With that in mind, Anthem in Virginia is pleased to announce a new Rehabilitation program. Effective August 1, 2022, for claims with dates of service on and after August 1, we will transition medical necessity review of physical, occupational, and speech therapy services for Anthem in Virginia’s Commercial fully insured members to AIM Specialty Health_® (AIM) – a separate company.

 

The new Rehabilitation program reviews certain treatment plans against clinical appropriateness criteria to help ensure that care aligns with established evidence-based medicine.  Anthem in Virginia will be utilizing the AIM Outpatient Rehabilitative and Habilitative Services clinical guidelines. Any qualified providers acting within the scope of their license who intend to provide therapy services are required to obtain a prior authorization from AIM. 

 

The Rehabilitation program takes into account individual clinical details in order to titrate the number of authorized visits on a request. We measure progress based on condition management and patient outcomes with additional visits approved as clinically appropriate.  Prior authorization is not required for members with a primary diagnosis of autism or ages birth to 3^rd birthday.

 

Unlike models that offer a one-size-fits-all approach, the Rehabilitation program reviews based on multiple clinical factors. 

 

For therapy services that are scheduled to begin on or after August 1, 2022, all providers must contact AIM to obtain prior authorization for the following non-emergency modalities:

 

• Physical therapy
• Occupational therapy
• Speech therapy

 

Training webinars

 

To help you prepare for this program, AIM and Anthem in Virginia are hosting a series of live webinar sessions and Q & A only webinar sessions that are designed for providers and office staff who will be requesting prior authorization.

 

Live Webinar Sessions with Q & A will cover topics such as:

 

• How the program and prior authorization request process work
• Which members and services will require prior authorization
• Demonstration of the AIM ProviderPortal and how to enter order requests
• Additional resources
• Q & A

 

We strongly encourage you and your practice to participate, even if you are already familiar with AIM and the ProviderPortal through other health plans or specialty programs.

 

How to access the webinars

We will be providing links in a separate notice so that you can register to attend upcoming webinars about the AIM transition.  Please consider registering to attend at least one training opportunity.  Your facilities attendance at an AIM training opportunity is highly encouraged. AIM solution specific training content will be made available to you upon completion of registration and prior to attending a webinar session. Reviewing the material ahead of the training will allow your facility to bring relevant questions to be addressed during the training.  Below is a summary of the type of training to be offered along with dates and times.  Watch for an upcoming notice with registration information.

 

TYPE OF TRAINING	DATE AND TIME
Live Webinar Session with Q & A	Tuesday, June 21, 2022         3 p.m. EST
Live Webinar Session with Q & A	Tuesday, July 5, 2022              3 p.m. EST
Q & A Only Session	Tuesday, July 12, 2022           3 p.m. EST
Q & A Only Session	Tuesday, July 26, 2022           3 p.m. EST
Q & A Only Session	Thursday, August 11, 2022 2 p.m. EST

 

How to submit a request for review

 

Starting July 18, 2022, providers can begin submitting requests for review or verify order numbers using one of the following methods:

 

Online
The AIM ProviderPortal_SM is available 24/7, fully interactive, and processes requests in real-time using clinical criteria. To register, go to https://aimspecialtyhealth.com/providerportal/. Registration opens July 18, 2022.

By phone
Call AIM Specialty Health toll free at 866-789-0158, Monday through Friday between 8 a.m. and 5 p.m. EST.

 

For more information:

 

Online

For resources to help your practice get started with the Rehabilitation Program, go to www.aimproviders.com/rehabilitation/.

 

AIM provider website helps you learn more about the program and provides access to useful information and tools such as order entry checklists, clinical guidelines, and FAQs.

 

To learn more about AIM, please visit www.aimspecialtyhealth.com.

By phone
Contact your Anthem in Virginia Provider Relations Department toll free at 800-676-BLUE between 8 a.m. and 6 p.m. EST.

 

Anthem and HealthKeepers, Inc. value your participation in our network, as well as the services you provide. We look forward to working with you to help improve the health of our members.

 

2167-0522-PN-VA