Greetings!

As a valued member of APTA VA we want to make sure you are aware of this information about Anthem as we know it may impact your practice. If you have any questions, please don’t hesitate to reach out to us.
 
Sincerely,
 
APTA Practice and Payor Relations Committee 
On 5/1/22, Anthem issued this notice Provider Communications (anthem.com) to introduce the implementation of the AIM prior authorization program in VA effective 8/1/22. Please review this notice and the associated links. Its particularly important to familiarize yourself with the AIM Clinical Guidelines and the section titled “Adjunctive and Alternative Treatments” for PT and the list of excluded codes. The guidelines can be found live online at: https://aimspecialtyhealth.com/resources/clinical-guidelines/rehabilitation-guidelines/. 

  • AIM recently revised the Clinical Guidelines. The most substantive revision is a change in determination for Dry Needling which is now considered Not Medically Necessary. APTA sent a comment letter to Anthem challenging this position.
  • Providers may submit comments/ evidence on the guidelines to [email protected]. Please be aware that AIM will not reflect your comments or input in this version of the guidelines but will consider feedback for future iterations of the document. 
 
Two important points: 
  1. Providers will require a preauthorization for all therapy services rendered on or after 8/1/22, whether for a new episode/start of care or for continuing care within an existing episode of care that started prior to 8/1/22.

  1. The implementation date is 8/1/2022 but providers can begin submitting requests 7/18/22 for DOS 8/1/22 and after.

Below please find the AIM/Anthem training webinar information and registration links. The chapter strongly encourages participation to ensure a smooth implementation process.

June 21 @ 3:00 PM EST

July 5 @ 3:00 PM EST

July 12 @ 3:00 PM EST

July 26 @ 3:00 PM EST

August 11 @ 2:00 PM EST
Rehab microsite was updated with new general provider Q&A links. Below are the dates and registration links:

May 10, 2022

August 16, 2022

November 8, 2022