Information Regarding "AIM Specialty Health"
Prepared by Dee Combs, Indiana STAR
Hello ISHA members,
Starting 4/1/19, some Anthem Blue Cross and Blue Shield Medicaid plans will be linked in with a company called ‘AIM Specialty Health’ to review and authorize all PT, OT and Speech episodes:
Plans Affected currently:
Evaluations do not require prior authorization (PA), but future appointments do.
The PA has to be completed in full before a new PA can be issued.
PA’s will not be extended.
PA request is submitted through AIM portal. If medical necessity is met, the PA will be approved right away. If medical necessity is not met right away, they approve 1 visit, and Clinical is submitted for review.
Review takes approximately 7 days.
There are a list of tools that can be used. If those tools are used during the evaluation, it is a greater chance the PA will meet medical necessity, and the PA will be approved right away.
AIM has a list of CPT codes they will consider.
Below is a link to the list of codes that can be approved:
Please let me know if you have any issues/concerns in your work setting.
Your individual facility billing/revenue cycle departments should have access to AIM’s information.