Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Reminder: Precertification requirements for DME providers are now in effect

December 30, 2014

[

Independence has delegated the responsibility for precertification of sleep studies and related equipment and accessories to AIM Specialty Health® (AIM), an independent company.

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 and Medicare Advantage HMO and PPO 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 ProviderPortalSM.

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 UpdateSM.

AIM is an independent company contracted with Independence to perform precertification for select services for most managed care members.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.

]

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.