APTA Colorado Association – AIM Utilization Management Notification
Help is needed both from Physical Therapists and the consumers of Physical Therapy services. What can you do?
Dear APTA Colorado Members,
As many of you are aware, Anthem Commercial (CA, CO, CT, GA, IN, KY, ME, MO, NV, NY, OH and WI) contracted with AIM Specialty Health for utilization management of Physical Therapy services which was to begin on 7/1/2019. Leaders of Colorado APTA have been working with leaders in the above-mentioned states and with National APTA in preparation for this rollout.
As we have approached the rollout of the program for 7/1/2019, APTA Colorado identified problems in the AIM utilization management (UM) that were system wide and very substantial. Due to these issues, providers have been unable to transition thousands of patients nationally into the AIM portal.
APTA National and multiple state Chapters (including Colorado) have been actively relaying concerns and specific examples of challenges in the AIM UM roll-out to Anthem BCBS and AIM, including face to face meetings.
The Colorado Chapter was notified July 2nd, 2019 that the implementation of AIM authorization for Anthem‘s Commercial Membership is temporarily delayed.
Notification received from AIM is as follows:
“Due to recent system issues, the July 1st implementation of the AIM Rehabilitative program for Anthem’s Commercial Membership is temporarily delayed. The system issues have been associated with portal connectivity, provider data and membership eligibility information. Effective today until July 31st, for requests in progress and for new requests, coverage for PT/ST/OT visits will not require a pre-authorization. The AIM Provider Portal and the AIM call center will begin accepting requests July 17, 2019 for dates of service August 1, 2019 and after. As we work to resolve these issues, we will also use it as an opportunity to provide additional training opportunities. Access the AIM Rehabilitation Provider Portal to register for an upcoming session. There are many resources to assist you (Portal Login/Registration Issues (800) 252-2021) and Rehab Questions [email protected]). We are dedicated to providing an efficient environment for providers to deliver effective therapy care and help patients avoid costlier invasive surgical procedures.”
The Chapter has been informed that as Orthonet is no longer a contracted entity with Anthem, that authorization through Orthonet is not required at this time.
National APTA and APTA CO continues to seek ongoing dialogue with Anthem and AIM, and further meetings are planned. We are aware on significant challenges with finding patients in the new AIM system, significant time delays for providing patient care and a lack of accurate listing of providers in the online database. We are concerned with claim denials based upon the potential inaccurate listing of providers in the AIM database.
Help is needed both from Physical Therapists and the consumers of Physical Therapy services. What can you do?
Physical Therapists:
We have attached a document you can provide to your clients: “Patient Advocacy Template Colorado Final Version”
APTA CO will continue to work on a State and National level to address the challenges and obstacles with this new UM requirements. The new APTA Colorado Utilization Management Discussion Circle will serve as a mechanism to provide ongoing updates.
Respectfully,
Cameron W. MacDonald, APTA Colorado President
Audrey Waldron, APTA Private Practice Chair
Stefan Van Dursen, Interim Practice Chair |
