Blue Cross and Blue Shield (BCBS) of North Carolina will implement a new sleep management program for sleep testing and therapy services on Dec. 1, 2017. The program will be administered by AIM Specialty Health®.
Providers will be required to obtain preauthorization for the following services: home sleep apnea tests, polysomnograms, titration studies, initial and ongoing treatment orders (APAP, CPAP, BPAP), and oral appliances. Most BCBS North Carolina members under the age of 65 will be affected by this program. Failure to obtain authorization prior to sleep testing and distribution of equipment and supplies for therapy will result in denied claims.
Providers can begin submitting preauthorization requests on Nov. 20 for services performed on or after Dec. 1 by contacting AIM by phone or by logging onto AIM’s ProviderPortal for sleep management. For more information, read the Sleep Management FAQs for Providers from BCBS North Carolina.
Learn more about issues such as preauthorization and utilization management on the AASM’s Private Payers webpage. Does your practice have additional coding-related questions? Visit the AASM’s Coding FAQ page or email us at firstname.lastname@example.org.