When a wastewater treatment plant (WWTP) uses anaerobic digestion (AD) on its sludge treatment line, the opportunity to install a sidestream deammonification process for the cost-effective removal of the N-rich reject water load generated by the sludge digester should be considered. In this context, the ANITA™ Mox process based on the moving bed biofilm reactor (MBBR) technology has been implemented at more than 30 full-scale facilities over the last 10 years to treat reject water from conventional AD or after thermal hydrolysis process (THP) to reduce the N-load and associated treatment costs on the WWTP. This paper reviews the lessons learned in the implementation of the ANITA™ Mox process at several WWTP in the US, Europe, and Australia.