Payment Policy Updates
APTA-PPS State Payment Resources
Information Bulletin: New APTA-PPS State Payment Resources on Administrative Burden and UM Issues
APTA and the Private Practice Section have developed a new member benefit to ease administrative burden so you can spend more time caring for your patients.
The State Payer Advocacy Resource Center is aimed at addressing state-level administrative burden and utilization management issues with commercial payers, state Medicaid programs, and more. APTA and PPS collaborated on this suite of payment advocacy tools, hosted as a resource center on the PPS website and available free to all APTA members.
This payment resource center is the latest of several newly developed tools aimed at state advocacy on payment. It follows the release earlier this year of resources compiled by APTA state affairs staff to help chapter leaders and legislative chairs pursue state legislation on payment issues, including model state bills addressing prior authorization, utilization management, prepayment review, and more.
Please review the letter from APTA president Roger Herr, PT, MPA, and PPS President Michael Horsfield, PT, MBA, regarding the new resource.
(Note: To access the resource site, first click on the “APTA-only Members Access SPARC Resources” button, then enter your APTA ID#. Password is your last name.)
The AIM Rehabilitative program for Anthem’s Commercial Membership is scheduled to relaunch November 1st for the following states: CT, ME, NH, NY, GA, IN, KY, MO, OH, WI. Requests may be submitted beginning October 21st via the AIM ProviderPortal.
For commercial plans only: requests for PT/ST/OT visits with dates of service beginning July 1 and thereafter will not require a prior authorization until the relaunch date. There are claims stop processes in place to allow providers to continue to provide treatment and allow claims to process.
AIM’s management of Anthem’s Medicare Advantage plans will launch March 1, 2020.
AIM continues to facilitate training sessions to provide an overview of the program, review available resources and demonstrate the AIM ProviderPortal. Access the AIM Rehabilitation Provider site to register for an upcoming session. For portal login issues call: (800) 252-2021. Rehab questions should be sent to firstname.lastname@example.org.
- If you experienced a significant increase in administrative burden during the time AIM was becoming operational, please report your concerns to APTA Kentucky.
- If your patients experienced a delay in care during the recent implementation period, you may file a complaint on their behalf with the Kentucky Department of Insurance.
- Download the Cohere December 2021 update. If you have any difficulties with any payor that has not been resolved, please contact Andrea O’Leary.
APTA Kentucky would like to know if you experience problems with AIM. This might include:
- Problems or delays receiving authorizations
- Denials of visits or reductions in visits requested (i.e. eight visits requested but only four visits authorized)
- Increase in administrative burden
If you experience any of these or other problems, please reach out to us.
APTA-PPS State Payment Resources
Log into your PPS account to gain access to resources curated specifically for the PT in business.