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PRE-AUTHORIZATION IS REQUIRED FOR THERAPY SERVICES

Anthem BCBS Changes Policy for Therapy Services Provided by DC’s and Other Health Care Providers.

Along with other health care providers that perform therapy services under the AIM Specialty Health® program, Wisconsin DCs that participate with Blue Cross Blue Shield (in-network providers) are required to obtain pre-authorization through AIM Specialty Health® (AIM) for therapy services. Other health care providers required to obtain pre-authorization include Occupational Therapy/Speech Therapy/Physical Therapy practitioners, Physical Therapists, MDs, DOs, NPs, APNs, and physical trainers.

This pre-authorization requirement does NOT apply to chiropractic adjustments. It only applies to Anthem BCBS patients for whom you provide therapy services as a participating, in-network provider with Anthem BCBS. If you have specific questions regarding getting pre-authorization for therapy services for your practice, including issues and/or difficulties with this process, please contact rehabprogram@aimspecialtyhealth.com.

Anthem BCBS can make changes to policy if they notify contracted providers in their network. Anthem sent out information to providers stating that Physical Therapy, Occupational Therapy and Speech Therapy services would be subject to prior authorization review, and provided parameters for this policy change; notices were published in Anthem’s July, October, and November 2019 provider education newsletters. Every insurance carrier has a method to notify its participating providers. If you did not receive notification of this policy change, please join the registration list to receive Anthem BCBS newsletters here: www.anthem.com/ provider/news – select Wisconsin, and then scroll down to click on the orange subscribe button. The following link to the AIM Rehabilitation website also provides helpful resources on physical therapy clinical guidelines: www.aimproviders.com/rehabilitation – select Resources in the top left; the following page provides access to physical therapy checklist and guidelines.

This policy change and pre-authorization requirement for therapy services is Anthem’s method of getting in front of the Medical Necessity process. Anthem wants to see Medical Necessity for these therapy services before it can pay on a claim and is trying to streamline the process. WCA has been in contact with Anthem BCBS and has researched this pre-authorization requirement from a policy as well as legal standpoint. If we had recourse to challenge this policy change, we would be doing so, as it is ALWAYS our mission to advocate for WCA members and the great profession of chiropractic.

Anthem has taken the necessary steps to institute and impose this change, and DCs as well as other health care providers that provide therapy services are now required, under Anthem BCBS policy, to adhere to this pre-authorization process to receive compensation for these services. It is because of this that WCA partnered with Anthem BCBS and presented a complimentary Help Desk webinar designed to educate and train member DCs on how to obtain the pre-authorization for therapy services.

The “Getting Pre-Authorization through AIM for Anthem BCBS” webinar was held on Sept. 10, 2020 and is available on the WCA website with your member login: https://wisconsinchiropractic.site-ym.com/page/webinars. Please visit this page and click on “Past On-Demand” Webinars under the “Past Webinars & Archives” heading. Access to this webinar, webinar slides, and additional resources are also available at https://wisconsinchiropractic.site-ym.com/page/eNews.

 

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