Updated AIM Rehabilitative program effective August 1, 2021 - Site of Care reviews

We are committed to being a valued healthcare partner in identifying ways to achieve better health outcomes, lower costs and deliver access to a better healthcare experience for consumers.

 

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 Anthem Blue Cross and Blue Shield (Anthem) 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 requested site of care. AIM will use the following Anthem clinical utilization management (UM) guideline: CG.REHAB.10 Level of care: outpatient physical therapy, occupational therapy, and speech-language pathology services. This clinical guideline can be reviewed online at 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 Anthem member on or after August 1, 2021, providers can contact Provider Services at 1-855-558-1443 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 prior authorization 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 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 Portal at 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 ProviderPortal 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

Anthem invites you to take advantage of a free informational webinar that will introduce you to the program and the robust capabilities of the AIM ProviderPortal_. 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.

 

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.