AIM Rehabilitative Program Site of Service Reviews Effective August 1, 2021
Effective 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. This site of service review will impact providers of therapy services in the following states:
- Connecticut
- Colorado
- Georgia
- Indiana
- Kentucky
- Missouri
- New Hampshire
- Nevada
- Ohio
Per AIM, pre-certification
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Effective 8/1/21 AIM will expand Rehabilitation program to perform medical necessity review of requested site of service for PT, OT and ST for Anthem fully insured members. What does this mean? Currently when a patient comes we do an IE and a treatment the same day. We then submit our IE codes along with the treatment codes over to AIM for certification. Effective 8/1/21, how is this changing? Thank you< Denise Sweeney
Please read the linked resources in the article. They will explain what this policy is and what it means.
AIM effective 8/1/2021: CG-REHAB-10 Site of Care: Outpatient PT, OT, ST services in the hospital outpatient or hospital outpatient clinic site of care, not independent PT, OT and ST practices not associated with a hospital. Therefore, is it safe to say AIM’s effective change 8/1/2021 does not apply to independent practices, we are already doing this?
This change for site of service review with HOD therapy appears restrictive for services with patients having general ortho types of care that would not require special equipment and other clinics in 15 mile radius. Seems challenging to meet this criteria for site review if you are a HOD in one of those states.
You are correct. This will be an eye-opener for hospitals. Keep in mind that UnitedHealthcare has already done something similar.
Hey Rick,
Can you tag the UHC policy for me?
Thanks
-Janet
What UHC policy? This article is discussing AIM and Anthem BC.
your comment above that UHC already has done something similar. Thanks!
United Health Care Community Plan did this in our state. At first it seemed like patients were only approved for therapy at private practices, but that seems to have shifted back now. I’m not sure what happened. Here’s the link to their policy. https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan/outpatient-physical-occupational-therapy-cs.pdf
We were not able to submit for PA prior to Aug 1 for Aug 1 IE for site of service here in NH. Just another flaw of AIM. This entire policy is alarming for not just the hospitals affected but other states that may follow suite..and in general PT, OT and SLP service deliveries if insurances make a blanket policy that truly should be individual contracts. I am glad to know that the APTA and the NHHA are working hard to fight this, though did not accept our last minute request to pause the roll out like some other states with success. More administrative burden we just don’t need!
Thanks RIck for keeping everyone informed.
I sat in on the AIM training and yes, the site review specifically applies to hospital out patient services.
I work at an independently-owned, small physical therapy office. Like Denise S. we have been required to use AIM for quite some time. I have read all of the linked resources and it seems that this new review mandate is for hospitals and hospital associated facilities? Doesn’t seem to be anything new/updated for our type of business?
I am from CT, and oversee a 4-site hospital OP dept. This would appear to be a breach of contract if we have an agreement with Anthem that covers hospital OP services. I have escalated to our Managed Care Team. They can’t change the game mid-stream in my opinion when there are contracts involved.
We have not had an Anthem case in a while. As an independent outpatient practice in Delaware, is prior authorisation through AIM required?
We are a Private Practice and we are also finding AIM is affecting Massachusetts Providers as well, with patients who have the Empire BCBS Plan or Unicare. Unicare has turned their “Utilization Review” over to AIM as of July 1st, creating a complete nightmare for both the provider and patients.