July 19, 2018
AIM Specialty Health® (AIM) started conducting clinical reviews for all sleep studies, treatment options of positive airway pressure (PAP) devices, and oral appliances for obstructive sleep apnea on behalf of Premera on January 1, 2018. As a reminder, you can find details about the administrative guidelines. We notified providers about this change in December 2017. This is a reminder and there aren’t new changes to our policy/guidelines for sleep studies and DME equipment.
Four key changes you should know about the guidelines:
- Register on the AIM provider portal if you haven’t done so already.
All care management related to PAP devices happens through the AIM provider portal. You must register with AIM to provide services to Premera customers.
- Sleep studies, PAP, and oral devices require AIM review and authorization.
Initial treatment order of a PAP or oral device requires authorization from AIM.
- Demonstrate your patients’ PAP compliance, using the AIM portal.
You must demonstrate compliance that patients’ use meets the minimum requirements every 90 days for the first year and annually after that. The new guidelines state that during at least one 30-day period every 90 days, patients must use their PAP machine a minimum of 4 hours a night, 5 nights a week. That’s 70 percent of the time or 21 nights in a 30-day month.
The PAP machines will send you a usage report. Premera will deny your patients’ claims if you don’t demonstrate compliance.
- Providers with patients currently using a PAP and/or oral device also need to follow AIM’s compliance guidelines.
You also need to follow the AIM compliance guidelines detailed above for patients that are currently using a PAP and/or oral device.
Visit www.aimspecialtyhealth.com/gowebsleep for further program information. You’ll have access to all sleep study guidelines and codes.