AIM has just published new “Clinical Appropriateness Guidelines” for PT, OT and ST that will be effective Oct. 1, 2020. Anthem in-network providers will be required to follow these guidelines, so you should review them in advance of Oct. 1. Contact Gwen if you have any questions or concerns about them.
New AIM Clinical Appropriateness Guidelines, effective Oct. 1, 2020 Read More »
We have reliable information that the following health plans DO NOT require AIM pre-authorization in Maine: Maine Health Maine Teacher’s Association (MEA Trust) CMP Federal BCBS AIM’s message when you try to obtain pre-auth for these plans tells you to call Anthem. You do not need to do this. I recommend, however, that you ask
Plans not requiring AIM pre-authorization Read More »
CLIENT ALERT Some Maine PT providers have received a letter from Anthem dated August 28, 2019 stating they did a review of claims between 2/1/2018 and 1/31/2019 and their utilization of CPT code 97110 was “outside the average utilization for your specialty.” The letter appears to be a template form. It is not even properly
Anthem and CPT Code 97110 Read More »
Anthem is starting to do audits on PT services. Some providers are being put on “pre-payment review” because their documentation is not meeting Anthem’s standards. Please review Anthem’s Clinical UM Guideline for PT services (CG-REHAB-04) published on 10/17/2018 for documentation requirements and other coverage policies. If you are audited and don’t agree with the outcome, especially
Anthem Audits & Documentation Requirements Read More »
