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New precertification requirements for DME providers

October 1, 2014

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

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 and PPO 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 Independence to perform precertification for select services for most managed care members.


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