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​​​​Carelon Medical Benefits Management (formerly AIM Specialty Health® (AIM)) Precertification/Preapproval for Sleep Disorder Testing; Positive Airway Pressure (PAP) Titration; and APAP, BPAP, and CPAP Machines and Related Supplies for Commercial Members

For most members enrolled in the Company’s commercial HMO and PPO products, the Company requires precertification/preapproval through Carelon Medical Benefits Management (formerly AIM Specialty Health® (AIM)) for the following services:

  • Facility-based sleep disorder testing and positive airway pressure (PAP) titration
  • Positive airway pressure therapy
  • Supplies related to PAP therapy

To direct the application of these services and devices for our members, Carelon utilizes their Sleep Disorder Management Diagnostic & Treatment Guidelines.* For more information about the services and devices that require precertification/preapproval, refer to the current version of medical policy #07.03.05: Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies.

*Carelon’s medical necessity guidelines are consistent with the clinical appropriateness criteria based on technology assessment, peer-reviewed medical literature including clinical outcomes research and consensus opinion in medical practice. To access the complete list of Carelon​ Sleep Disorder Management Diagnostic & Treatment Guidelines, click here.