Reminder and update: new Rehabilitative Program effective July 1, 2019

As previously communicated in the April 2019 provider newsletter, AIM Specialty Health® (AIM), a separate company, will begin to perform prior authorization review of rehabilitative (restoring function) and habilitative (enhancing function) services for Anthem Blue Cross and Blue Shield (Anthem) commercial fully insured members beginning July 1, 2019. Currently, OrthoNet LLC is performing medical necessity reviews for physical and occupational therapy services for Anthem. These reviews, in addition to speech therapy service reviews, will transition to AIM.

 

The AIM Rehabilitative Program began April 1, 2019 for Anthem Medicaid members in Indiana and Wisconsin.

 

AIM will 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 following the initial evaluation. AIM will use the following Anthem Clinical UM Guidelines:

• CG-REHAB-04 Physical Therapy
• CG-REHAB-05 Occupational Therapy
• CG-REHAB-06 Speech-Language Pathology Services

 

The clinical criteria used for these reviews can be found on our anthem.com Clinical UM Guidelines page. A complete list of CPT codes requiring prior authorization for the AIM Rehabilitative Program is available on the AIM Rehabilitation microsite. There you can access additional helpful information such as order entry checklists and FAQs.

 

AIM will now begin accepting prior authorization requests on June 24, 2019 for dates of service on and after July 1, 2019.  Ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal^SM directly at 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 availity.com.
• Call the AIM Contact Center toll-free number 800-554-0580, 8:30 a.m.–7:00 p.m. ET.

 

Need training?

Anthem invites you to take advantage of an informational webinar that will introduce you to the Rehabilitative Program and the robust capabilities of the AIM ProviderPortalSM.  Visit the AIM Rehab microsite to register for an upcoming training session.