Sleep Medicine program
Our Sleep Medicine program is an extension to our existing utilization management (UM) program. The program is designed to manage testing and therapy services for sleep disorders and is administered by AIM Specialty Health (AIM). Services managed under this program include:
- Titration studies
- Home sleep testing (HST)
- Oral appliances for sleep therapy
- In-lab sleep studies (polysomnography PSG)
- Initial treatment order (automatic positive airway pressure APAP, continuous positive airway pressure CPAP, bilevel positive airway pressure BiPAP)
Ongoing treatment orders (APAP, CPAP or BiPAP)
Physicians and other health care professionals ordering services listed above must first contact AIM to request an order number prior to services being rendered. View the codes that require an order number on our Pre-authorization Lists.
This applies to procedures performed in the following settings:
- Free-standing sleep center
- Outpatient hospital setting
- Outpatient basis in a physician office
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. Authorization for ongoing sleep therapy will be dependent on member compliance data provided to AIM by the durable medical equipment (DME) vendor.
- Supplies for APAP, CPAP and BiPAP do not require pre-authorization
- Compliance information for APAP, CPAP, BiPAP must only be submitted during the rent-to-purchase period. Once the equipment has been purchased, we do not require compliance information.
- Services performed in conjunction with any of the following are excluded from the program:
- Urgent care facilities
- Inpatient hospitalization
- Emergency room services
- The program applies to new and existing sleep therapy patients.
- Ordering physicians (those referring the member for sleep testing) and servicing providers (free-standing or hospital laboratories that perform sleep testing) may submit order requests.
- If AIM determines the service does not meet medical necessity criteria, the requested procedure will be denied and an order number will not be provided.
If a sleep medicine provider performs the service without an approved order number, the procedure will be considered a provider write-off and cannot be billed to the member.
Members included in the program
This program applies to members residing in Idaho, Oregon, Utah and Washington.
Determine whether your patient's plan participates in this program by using the electronic authorization tool on the Availity Portal.
An administrative services only (ASO) group may decide to purchase this benefit during their annual renewal period. The renewal period can vary by month, depending on the group. It is therefore important to check the electronic authorization tool on the Availity Portal to determine if a patient's plan has changed.
Submitting requests for sleep testing and therapy services
Ordering physicians (those who refer the member for sleep testing and therapy) and servicing providers (those who provide the sleep testing and therapy) may submit requests for sleep testing and therapy on behalf of members. Note: DME suppliers may only submit requests for sleep therapy services.
Contact AIM online via AIM's ProviderPortal or call toll-free at 1 (877) 291-0509, 8 a.m. - 5 p.m. PST Monday through Friday to request an order number. A provider's office can often get an immediate approval when they submit a request online.
Obtain an order number
- Login or register with AIM's ProviderPortal
- Phone 1 (877) 291-0509
View workarounds for AIM system outages
View the codes that require an order number on our pre-authorization lists.
Register with AIM to order sleep studies or DME services
Providers currently using AIM's website for radiology authorizations do not need to register again. All other providers who will require access to the AIM website to obtain authorization or check on authorization status must register. For large group practices, AIM can help with the registration process.
- Phone 1 (877) 291-0509
Completing the OptiNet assessment
Facilities, sleep laboratories and DME providers must complete an online assessment on AIM's OptiNet.
OptiNet is an online provider registration tool that collects information on the facility, such as services, staffing and accreditation. Facility, sleep laboratory and DME provider data provided will become an important part of the information available to ordering physicians and members.
If you have not previously registered with AIM, you will first need to do so. The registration tool is available through the ProviderPortal.
You can complete your OptiNet registration at your convenience; you can initiate, pause and save your progress as needed. Select Regence from the drop-down menu, and proceed with the assessment.
Note: You do not need to complete the survey if you only read sleep testing results and do not perform the technical and/or global component of these services.
The information gathered from the OptiNet registration will:
- Be made available to ordering physicians during the sleep management request process and used to educate users in the Provider Selection component of the order request process.
- Allow ordering physicians to choose a servicing provider from the online directory based on their ability to provide home sleep testing, facility-based sleep testing and DME services.