Prior authorization requests may be submitted via the AIM ProviderPortal SM or by calling 86, Monday – Friday, 8:00 a.m. Please note, this does not apply to procedures performed in an inpatient or observation setting, or on an emergent basis, members currently in an episode of care at the start of the program, services with diagnosis of autism, and members ages birth to third birthday.ĪIM will begin accepting prior authorization requests on July 19, 2021, for services provided on or after August 1, 2021. Requests that are not medically necessary at a hospital site may be approved for coverage at a free standing or office-based setting.ĪIM will use the following Anthem Clinical UM Guidelines: CG-REHAB-10 Site of Care: Outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services. After the evaluation, ongoing services will be subject to site of care review and require prior authorization, including post service review which may result in a not medically necessary denial of coverage for the site of care. Prior authorization is recommended for the initial evaluation service codes, unless otherwise prohibited, to alert the provider of the site of care program and help ensure the member is receiving care at the appropriate site of service early in the process. Per AIM, pre-certification will be required for all outpatient facility and office-based rehabilitative and habilitative services. This site of service review will impact providers of therapy services in the following states: Board-Certification in Women's Health Physical Therapyīecoming a Pelvic Health Physical Therapist (PT)īecoming a Pelvic Health Physical Therapist Assistant (PTA)Įffective August 1, 2021, AIM Specialty Health® (AIM), a separate company, will expand the AIM Rehabilitative program to perform medical necessity review of the requested site of service for physical, occupational and speech therapy procedures for Anthem fully-insured members.
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