Effective Jan. 1, 2018, AIM Specialty Health® (AIM) will conduct clinical reviews for all sleep studies, as well as the treatment options of positive airway pressure (PAP) devices and related supplies and oral appliances for obstructive sleep apnea.
- Home studies: Unattended home sleep studies will require prior authorization.
- In addition to other criteria, two home sleep studies may be required before prior authorization is given for a facility-based study.
- Inpatient sleep studies for non-respiratory disorders will require prior authorization.
- Pediatric sleep studies will require prior authorization.
- Titration study: These require prior authorization through AIM.
- PAP devices and related supplies:
- Initial treatment order of a PAP device requires prior authorization.
- Demonstration of compliance is required every 90 days for the first year and annually thereafter. Claims will be denied if compliance isn't demonstrated.
- AIM will monitor patient treatment compliance via data verification directly from patients' devices before supplies are dispensed. If compliance isn't demonstrated, the claims for replenishment supplies will be denied.
- Oral appliances: These require prior authorization through AIM.
Providers will need to submit requests for prior authorization on the AIM provider website for dates of service Jan. 1, 2018, and later. Beginning December 18, 2017, providers will have access to online approval tools through AIM for prospective reviews. Visit www.aimspecialtyhealth.com/gowebsleep for program information and to review all sleep study guidelines and codes.