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Physical therapists who bill Anthem Blue Cross-BlueShield (BCBS) in California, New York, Indiana, Wisconsin, and Louisiana, get ready for a change: there's a new utilization management (UM) vendor in town.

APTA has learned that Anthem BCBS is migrating to a new UM vendor, starting with the 5 states listed above. The new UM group is a subsidiary of Anthem known as AIM Specialty Health and replaces previous UM vendor OrthoNet in Medicaid states

The migration will begin March 1, 2019, for Medicaid patients in New York, Indiana, Wisconsin, and Louisiana. The shift won't happen in California until March 15, 2019, and will include all commercial enrollees. But the migration isn't likely to stop there, according to Elise Latawiec, PT, MPH, APTA lead senior practice management specialist.

"Anthem also operates in Colorado, Connecticut, Georgia, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Virginia, and manages specialty plans in several other states. From the information received thus far we expect the migration to impact all lines of business in the coming year," Latawiec said, adding that APTA has asked Anthem to notify the association as far in advance as possible so that we may alert membership to the change.

The new UM system also includes occupational therapy and speech-language-hearing services, and applies to any outpatient place of service, including both on- and off-campus hospital facilities. Anthem BCBS will require that the new UM be applied for patients with all diagnoses for which treatment is delivered in the outpatient setting.

AIM is holding a series of initial training sessions January 24, January 30, February 24, and February 26, and says it will reach out to invite current Anthem providers to the webinars. Anyone unable to attend a scheduled session will be able to access a recorded version following the 4 trainings.

APTA will meet with AIM representatives for a follow-up conversation after the initial rollout.

Want to get a better understanding of the ins and outs of UM? Check out APTA's Utilization Management Toolkit, a members-only online resource with tips, common challenges, and strategies of addressing UM issues.


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