Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline

This communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).

 

Effective for dates of service on and after August 16, 2020, the following updates will apply to the AIM Specialty Health_®* (AIM) Sleep Disorder Management Clinical Appropriateness Guideline.

 

Sleep Disorder Management Clinical Appropriateness Guideline updates by section:

• Bi-Level Positive Airway Pressure (BPAP) Devices:
  • Change in BPAP FiO2 from 45 to 52 mmHg based on strong evidence and alignment with Medicare requirements for use of BPAP
  • Multiple Sleep Latency Testing and/or Maintenance of Wakefulness Testing:
• Style change for clarity
  • Code changes: none

 

As a reminder, ordering and servicing providers may submit prior authorization (PA) requests to AIM by:

• Accessing AIM’s ProviderPortal_SM directly at com. Online access is available 24/7 to process orders in real time, and is the fastest and most convenient way to request PA.
• Accessing AIM via the Availity Portal.*
• Calling the AIM Contact Center at 1-800-714-0040 from 6 a.m. to 6 p.m. CT.

 

What if I need assistance?

If you have questions related to AIM guidelines, email AIM at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

 

* 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.

 

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