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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 and Medicare
Advantage HMO and PPO 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), an independent
company, 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 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.
]