Clarification to the Anthem Blue Cross Blue Shield Implementation of Pre-Authorization for Outpatient Therapy
Preferred Therapy Solutions continues to provide its partners with information that may impact rehabilitation services, compliance or regulatory requirements. The below information clarifies the significant change in pre-authorized outpatient therapy as defined by Anthem Blue Cross Blue Shield.
Effective August 1, 2019, Anthem Blue Cross patients in several states will require pre-authorization to receive outpatient PT, OT and ST services.
States that will be impacted are:
California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin.
Please note, that Skilled Nursing Facilities are excluded from the list of settings and places of service that require pre-authorization of PT, OT, and ST out-patient services. It is essential, however, that each provider continues to follow current practices, and should review their Anthem BCBS contract, as well as the health plan of each resident/beneficiary.
AIM Specialty Health is overseeing this new program. AIM’s Rehabilitation Program provides a “clinical appropriateness review process that encompasses the appropriate duration of rehabilitation services.” The program includes a review of rehabilitative and habilitative outpatient PT, OT and ST services for medical necessity.
Preferred Therapy Solutions will partner with facilities affected by this change to prepare for the transition and, as always, we will be available for ongoing education and consultation. We have reviewed the clinical guidelines and will work with clinicians in those settings that will require this change to ensure clinical compliance. Below you will find additional information and resources.
AIM has set up a portal and call center to address provider concerns and questions. AIM will provide educational resources, guidelines, and will offer educational webinars.
AIM Contact Information & Resources:
AIM support line: (844) 423-0883
Portal Login Issues: (800) 252-2021
Rehab Questions: email@example.com
PTS will continue to monitor for updates and keep our valued partners informed. If you have any questions, please contact Barbara Blatt, Appeals Management Coordinator