Sleep Disorder Management Program

Horizon BCBSNJ is working with AIM Specialty Health® (AIM), a specialty benefits management company, to offer a Sleep Disorder Management Program to certain self-insured employer group health plans administered by Horizon BCBSNJ that engages health care professionals in the management of the complexities associated with sleep disorders.

The AIM Sleep Disorder Management Program is designed to help members make more informed decisions regarding their care for sleep testing and therapy. We are committed to administering a comprehensive solution for sleep disorder management, designed to:

• Improve the clinical appropriateness of sleep therapy testing and services
• Help members find the highest value place of service for testing and therapy
• Monitor and manage patient compliance of sleep therapy

Prospective Clinical Case Review

AIM performs prospective clinical appropriateness case review Prior Authorization & Medical Necessity Determination (PA/MND) for sleep testing and therapy for Horizon BCBSNJ members. The following services are included in the program:

• Home sleep test (HST)
• Initial treatment order (APAP, CPAP, BPAP)
• In-lab sleep study (PSG, MSLT, MWT)
• Ongoing treatment order (APAP, CPAP, BPAP)
• Oral appliances
• Titration study

This program pertains to both new and existing sleep therapy patients.

Providers should contact AIM to obtain an order number before scheduling or performing any elective outpatient home-based (unattended) diagnostic study or a facility-based diagnostic or titration study (free-standing or hospital) as well as for sleep treatment equipment and related supplies.

Services performed in conjunction with Emergency Room services, inpatient hospitalization or urgent-care facilities are excluded. Both ordering physicians (those referring the member for sleep testing) and servicing health care professionals (those free-standing or hospital labs that perform sleep testing) may submit requests.

To submit a request, register or sign on at aimspecialtyhealth.com/gowebsleep. You may also call AIM Specialty Health at 1-866-766-0250, then press 1, Monday through Friday, from 9 a.m. to 6 p.m., Eastern Time (ET).

For more information
Helpful information, guidelines and order entry worksheets are available at aimspecialtyhealth.com/gowebsleep.

For general information about AIM Specialty Health, call 1-847-564-8500, Monday through Friday, from 9 a.m. to 6 p.m., Eastern Time (ET).

Please reference the Sleep Disorder Management order entry worksheets before submitting your request. These resources are available on the AIM Sleep website at aimspecialtyhealth.com/gowebsleep.

For More Information
Horizon BCBSNJ’s sleep disorder management program follows the AIM Clinical Appropriateness Guidelines for Sleep Disorder Management. The AIM clinical guidelines for sleep medicine are developed and revised through a rigorous review process that uses a comprehensive assessment of existing guidelines, evidence based standards and literature, and extensive feedback from the AIM External Physician Specialty Advisory Panel, which includes board-certified physicians from both community and academic practice. The clinical guidelines for sleep can be accessed at aimspecialtyhealth.com.

Thank you for your participation. We appreciate your continued service to our members, your patients.

AIM Specialty Health® is a registered trademark of American Imaging Management, Inc.

American Imaging Management, Inc. supports Horizon Blue Cross Blue Shield of New Jersey in the administration of specialty benefits management. American Imaging Management, Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.