AIM Specialty Health November 2019 Updates

October 21, 2019
Rick Gawenda

If you submit claims to Anthem Blue Cross, significant changes are occurring beginning with dates of service on and after November 1, 2019. AIM Specialty Health has announced they will relaunch the AIM Rehabilitative program (i.e. prior authorization) for Anthem’s Commercial Membership on November 1, 2019 for the following states:

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  1. I am California and they are starting to blanket deny all claims for lack of pre authorization through AIM. We now have to call on each Anthem patient to have claims reprocessed. They want to push another 30-45 days for reprocessing unless you specifically request for expedited review due to the denial being an error in their system. I imagine there is nothing that can be done while submitting claims to prevent this.

    1. Here is the message CPTA received from AIM officials regarding the error:

      “One of the Anthem claims systems (WGS) was configured for the auth-claims stop only until 10/1/19 so claims coming in after 10/1 were erroneously looking for an auth from AIM. The Claims team at Anthem is getting that configuration corrected expeditiously and doing a claims re-processing project to pay those dates. There is no additional work needed from the providers, but as always you can call the Anthem Customer Service number on the denial letter for further information.”

      Providers who may be impacted by the Anthem major claims error are encouraged to contact the DMHC for provider complaint support at 1 (888) 466-2219 or online here.

  2. We’re running into issues when attempting authorization requests through AIM. Are there any known issues since the 11/1/19 launch date?

  3. Just got off the phone with AIM because I have a BCBS patient whom I was told by the plan they are NOT moving precert to AIM. I spoke with AIM and this is true… they are only precerting certain BCBS and it just depends on the plan as to whether or not they are working with that plan. So have your front office staff call each plan before treatment and make sure that they do not need precert somewhere else other than AIM. Also they do NOT have a phone number on their website for you to call other than website issues… well the phone number to call other than website problems is 800-714-0040 option 9 for rehab. You will need to also call this number at times for verification, when the aim portal doesn’t give you a case number to see if you are approved or not. You will also need to use this number if you need peer to peer. Oh, and sometimes you might need to call the plan and if the plan says that AIM is doing the precert but AIM is asking for a pin or something similar then you will need to have the plan 3 way you with AIM so they can do your precert over the phone instead of online. She also told me that if you were unable to get dates precerted then claims will be denied… use this number to call them and give them your claim number and they will re process it and have it paid but they can only do this with the claim number and at the listed phone number above.

  4. If patient has a BCBS of CT plan but billing and treatment is being done in the state of Massachusetts which is not required to get AIM authorization do we still need to get an auth?