Obstructive Sleep Apnea (OSA) is a serious condition which is, fortunately,
being diagnosed and treated at an increasing rate. OSA care is predicted to
grow at 6 percent annually. In order to help our members receive care that is
appropriate, safe, and affordable, AmeriHealth has delegated the responsibility
for precertification of sleep studies and related equipment and accessories to
AIM Specialty Health® (AIM).
As was previously communicated, effective January 1, 2014, ordering
physicians must submit precertification requests for sleep studies and CPAP
titration studies in a facility setting through the AIM
ProviderPortalSM for all commercial and Medicare Advantage HMO
members.
Effective January 1, 2015, APAP, BPAP, and CPAP machines
and replacement supplies (tubing, water chambers, face masks, etc.) will
require precertification by the durable medical equipment (DME) provider to
ensure that appropriate devices and the appropriate quantities of supplies are
being dispensed. Precertification for these items will be handled by AIM using
the AIM ProviderPortal.
Later this month, affected DME providers will receive a letter describing
the precertification process through AIM in greater detail. Additionally, look
for more information about this change in future editions of Partners in
Health UpdateSM.
AIM is contracted with AmeriHealth to perform
precertification for select services for most managed care members.