AmeriHealth has delegated the responsibility for precertification of sleep studies and related equipment and accessories to AIM Specialty Health^® (AIM).

As of January 1, 2015, durable medical equipment (DME) providers are required to obtain precertification for all APAP, BPAP, and CPAP machines, supplies (e.g., tubing, water chambers, face masks), and replacement supplies for all commercial HMO, POS, and PPO and Medicare Advantage HMO members.

Precertification request process

Currently, DME providers should submit these precertification requests using the Authorizations transaction in the NaviNet^® web portal. Later this year, enhancements will be made in NaviNet to allow the submission of these requests directly through AIM, using the AIM ProviderPortal^SM .

Affected DME providers will receive a letter in late January describing the precertification process through AIM in greater detail.

More information

A medical policy will be forthcoming that outlines the supplies that require precertification as well as the guidelines that will be used to determine medical necessity.

Additionally, look for more information about this process in future editions of Partners in Health Update^SM.

AIM is contracted with AmeriHealth to perform precertification for select services for most managed care members.