As previously communicated in the October 2019 edition of Anthem Blue Cross and Blue Shield (Anthem)’s Provider News, the AIM Rehabilitative program for Anthem’s commercial membership relaunched November 1, 2019. 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may be submitted via the AIM ProviderPortal for dates of service November 1, 2019 and after.The OrthoNet program is no longer active in applicable markets.


The AIM Rehab Program follows the Anthem Clinical Guidelines (CG-Rehab-04) that state the skilled services must be delivered by a licensed physical therapist or other qualified licensed health care professional. Qualified providers acting within the scope of their license, including chiropractors, who intend to provide the CPT codes for PT, OT or ST services referenced in this Clinical Guideline should request prior authorization (where permitted by law)  for those services through AIM.


New Changes to AIM’s Rehab Program


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


Effective November 1, 2019 in the states of Indiana, Kentucky, Missouri, Ohio and Wisconsin, prior authorization is not required for PT, OT, or ST outpatient therapy services when receiving skilled treatment for Autism Spectrum Disorder or Pervasive Developmental Delays for members with Anthem commercial plans. You may file your claims without a prior authorization number if you are billing with one of the following ICD-10 codes: F84.0, F84.2, F84.3, F84.5, F84.8, or F84.9. Please note that benefit limits, if applicable, will still be applied.


For the Medicaid states of Indiana and Wisconsin, there are no changes to the existing program.


Anthem is also transitioning vendors for review of Rehabilitative Services for our *Medicare members to include outpatient PT, OT, and SLP, to AIM Specialty Health. Anthem has decided to delay the implementation of this transition. The AIM Rehab program 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 in the states of Florida, New Jersey and New York for whom prior authorization will still be required.


Be sure to check upcoming editions of Provider News for more information about the AIM Rehabilitative Program for Medicare members.


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December 2019 Anthem Provider News - Wisconsin