December 7, 2017
Starting January 1, 2018, AIM Specialty Health® (AIM) will conduct clinical reviews for all sleep studies on behalf of Premera. AIM will also manage treatment options for positive airway pressure (PAP) devices and related supplies/oral appliances for obstructive sleep apnea.
This change affects all providers that manage sleep-related care for customers, (e.g. Durable Medical Equipment suppliers, sleep centers, and dentists). There are four important changes that you'll need to know about the new policy:
- All providers need to register on the AIM provider website if they have not done so already.
All care management related to PAP devices will happen through the AIM provider website. You'll need to register with AIM in order to provide services to customers after January 1, 2018.
On December 18, 2017, you'll have access to online approval tools through AIM for prospective reviews for January 1, 2018 and beyond.
- Sleep studies, PAP, and oral devices require AIM review and authorization.
Initial treatment order of a PAP or oral device requires authorization from AIM.
- Providers, including DMEs, need to demonstrate ongoing patient compliance through the AIM provider website. Providers with patients currently using a PAP and/or oral device also need to follow these AIM compliance guidelines:
During the first year of treatment, you'll need to demonstrate your patient's compliance every 90 days, showing that your patient's use of the device meets minimum requirements.
After the first year, you'll need to demonstrate your patient's compliance annually.
Premera will deny claims if you don't demonstrate your patient's compliance.
Visit AIM's website for further program information. You will have access to all sleep study guidelines and codes.