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Effective January 1, 2015, durable medical equipment (DME) providers
will be required to obtain precertification for all APAP, BiPAP, and CPAP
machines and replacement supplies (tubing, water chambers, face masks, etc.)
for all commercial HMO and PPO and Medicare Advantage HMO members.
In the first quarter of 2015, enhancements will be made to the
NaviNet® web portal to accommodate the submission of these
requests through AIM Specialty Health® (AIM) using the AIM
ProviderPortalSM. In the meantime, providers should continue to
submit requests for APAP, BiPAP, and CPAP machines and replacement supplies
using the Authorizations transaction in NaviNet.
As of January 1, 2014, ordering physicians began submitting precertification
requests for sleep studies and CPAP titration studies in a facility setting
through the AIM ProviderPortal. These precertification processes help to ensure
that our members receive care that is appropriate, safe, and affordable.
More information about this change will be communicated in future editions
of Partners in Health UpdateSM.
AIM is contracted with AmeriHealth to perform
precertification for select services for most managed care
members.
NaviNet® is a registered trademark of NaviNet,
Inc.
]