Effective March 13, 2022, AIM Specialty Health® (AIM) will implement two updates for the Musculoskeletal (MSK) Therapies (Rehab) program for Blue Cross Community Centennial (Medicaid) members:
- Medicaid members participating in an Early and Periodic Screening and Diagnostic Testing (EPSDT) program will now require authorization of therapy services (PT/OT/ST) through AIM.
- Medicaid members in an EPSDT program with a current therapy authorization from Blue Cross and Blue Shield of New Mexico (BCBSNM) will not require authorization through AIM until the currently authorized timeframe expires or visit allocation has been rendered.
- AIM will authorize Medicaid member therapy requests in a quantity of visits (dates of service) to review for medical necessity in intervals throughout the episode of care, aligning with AIM’s standard MSK Therapies (Rehab) program.
Training Webinars
To help you prepare for these program updates, we are hosting a series of live webinar sessions and Q & A only webinar sessions that are designed for providers and office staff who request prior authorization.
Live Webinar Sessions with Q & A will cover topics such as:
- Updates to the MSK Therapies (Rehab) program
- Overview of the MSK Therapies (Rehab) program
- Demonstration of the AIM ProviderPortalSM and how to enter order requests
- Share additional resources
- Q & A
We strongly encourage you and your practice to participate, even if you are already familiar with AIM and the ProviderPortal.
How to Access the Webinars
Please register to attend at least one training opportunity. Your organization’s attendance at an AIM training opportunity is highly encouraged. AIM solution specific training content will be made available to you upon completion of registration and prior to attending a webinar session. Reviewing the material ahead of the training will allow your facility to bring relevant questions to be addressed during the training.
| SOLUTION | TYPE OF TRAINING | DATE | MEETING INFORMATION |
|---|---|---|---|
| MSK Therapies (Rehab) | Live Webinar Session with Q& A | Tuesday, February 22, 2022 @ 2:00 pm CST | February 22, 2022 Registration Link  |
| MSK Therapies (Rehab) | Live Webinar Session with Q& A | Tuesday, March 8, 2022 @ 2:00 pm CST | March 8, 2022 Registration Link |
| MSK Therapies (Rehab) | Q & A Only Session | Tuesday, March 22, 2022 @ 2:00 pm CST | March 22, 2022 Registration Link |
Check Eligibility and Benefits First:
Check eligibility and benefits first to confirm membership, check coverage, determine through Availity® or your preferred vendor if you are in-network for the member’s policy and determine whether prior authorization is required. This step will help you confirm coverage and other important details, such as prior authorization requirements and the vendor to which the prior authorization request should be made, if applicable.
Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Prior authorization of a service is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.
Avoid claim denials or delays by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
How to Submit a Request for Review:
Providers can submit requests for review or verify order numbers using one of the following methods:
| Online | By Phone |
|---|---|
| The AIM ProviderPortal is available 24/7, fully interactive, and processes requests in real-time using clinical criteria. |
Call AIM Specialty Health toll-free at 877.291.0513, Monday through Friday between Monday-Friday 7AM-7PM CST. |
Resources for Your Practice:
AIM provider websites help you learn more about the program and access helpful information and tools:
- Order entry checklist
- Clinical Guidelines
- FAQs
More Information:
Refer to the updated prior authorization CPT Code Lists section in the Prior Authorization area of bcbsnm.com/provider. The code changes will be designated with dates of removal or addition.
Refer to the Blue Cross Centennial Community MSK Therapies (Rehab) Program Update FAQ for more information on the updates.
Read more about the AIM Rehabilitation Program on the AIM website.
For more information about AIM, please visit AIM Specialty Health website .
For more information about prior authorization, please contact BCBSNM’s Provider Customer Service at 888-349-3706, or BCBSNM’s Member Customer Service by calling the phone number on the back of the Member ID card.
CPT copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSNM to provide utilization management services for members with coverage through BCBSNM.
The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
Such services are funded in part with the State of New Mexico.