As you all are likely aware, Anthem is rolling out the AIM Specialty Health program for its commercial enrollees effective November 1, 2019. An official Anthem update and a Q&A are found below.
Please remember: Keep the Chapter informed of issues experienced as this rollout progresses.
Official Anthem UPDATE
This update was posted in Anthem’s newsletter and is available here.
UPDATE: new AIM Rehabilitative Program will begin November 1, 2019 Published: Oct 1, 2019 We announced in July that the AIM Rehabilitative Program for Anthem’s Commercial membership was delayed. The AIM Rehabilitative Program for prior authorization for physical, speech and occupational therapy services is scheduled to relaunch on November 1, 2019. Prior authorization requests for dates of service on or after November 1 may be submitted beginning October 21 via the AIM ProviderPortalSM. Coverage for physical, speech and occupational therapy services with dates of service July 1, 2019 through October 31, 2019 will not require prior authorization; processes have been created to allow providers to continue to provide treatment and to allow claims to adjudicate for those dates of service without authorization. Claims that were denied for no authorization in error for dates of service after July 1, 2019 are being reprocessed. The OrthoNet program is no longer active in applicable markets. We invite you to take advantage of an informational webinar that will introduce you to the Rehabilitative Program and the capabilities of the AIM ProviderPortalSM. Visit the AIM Rehabilitation microsite to register for an upcoming training session.
- What states will be impacted by the 11/1/19 Commercial rollout?
The states impacted by the 11/1/19 commercial rollout are: CT, GA, IN, KY, ME, MO, NH, NY, OH, and WI.
- Will additional states be impacted by the commercial rollout in the future?
Yes. CA, CO, NV have been delayed to work on provider data challenges but are projected to go live on 2/1/20. VA is not going live right now and there is no known effective date.
- Are all Commercial enrollees included in the 11/1/19 rollout?
No. The commercial rollout only includes fully insured enrollees. Self-insured employers have the option to buy in to the AIM program if desired.
- When will I need to start getting services approved by AIM?
Consistent with the above notification, prior authorization approval is required from 11/1/19 and beyond.
- When can I start getting commercial prior authorizations processed by AIM?
The AIM system will open to process commercial prior authorization requests on 10/21/19.
- How should I verify that an enrollee requires prior authorization?
AIM previously thought Availity would provide the “source of truth” on eligibility. However, it is now recommended providers come to the AIM portal to be sure if prior authorization is needed.
- If I am an out of network provider with Anthem, do I need to get services prior authorized?
Anthem is preparing an update on this question that will be shared as soon as available.
- Where should I go to get questions answered before and after the rollout?
Providers with concerns should contact AIM at: RehabProgram@aimspecialtyhealth.com and someone will research their issue and provide a timely response. If you contact the state-based Anthem Blues and the representative is unable to answer your inquiry or resolve the issue, please inform the chapter so we may assist and provide feedback to Anthem.
- Where can I find the list of available training dates to prepare for the commercial rollout?
The training dates and sign ups can be found here https://aimproviders.com/rehabilitation/
- Does Anthem post updates to the program?
Yes. Updates go out to providers and are found in the monthly Anthem newsletter at this site: www.Anthem.com -> Providers -> News -> Select your state.
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