California
Provider Communications

December 2018 Anthem Blue Cross Provider Newsletter - California

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Title Category

2019 FEP Benefit information available online

Federal Employee Plan (FEP)

2019 Medicare Advantage individual benefits and formularies

Medicare

An overview of our medical necessity review process

Policy Updates

Anthem Blue Cross accepts electronic prior authorization requests for prescription medications online

Pharmacy

Anthem Blue Cross provider directory and provider data updates

Administrative

Anthem Blue Cross works to simplify payment recovery process for National Accounts membership

Administrative

Anthem works to help ensure appropriate billing of E&M services

Reimbursement Policies

Availity to serve as EDI entry point for electronic submissions

Administrative

Benefit change for Infliximab for Federal Employee Program

Federal Employee Plan (FEP)

Case management program

Products & Programs

Claims requiring additional documentation

Medi-Cal Managed Care

Claims requiring additional documentation

Cal MediConnect

Claims system updates for 2019: Professional

Administrative

Clinical practice and preventive health guidelines available online

Policy Updates

CMS Medicare Preclusion list effective April 1, 2019

Medicare

Coding spotlight: Substance use disorders and smoking

Medi-Cal Managed Care

Coding tip: Claims processed with Modifier 79 should be reported by the same health care professional

Administrative

ConditionCare program benefits patients and physicians

Products & Programs

Contracted provider claim escalation process

Administrative

Coordination of benefits for an Federal Employee Plan member

Federal Employee Plan (FEP)

Coordination of care

Products & Programs

Easily update provider demographics with the online Provider Maintenance Form

Administrative

Electronic data interchange gateway update

Medi-Cal Managed Care

Electronic data interchange gateway update

Cal MediConnect

HEDIS 2018: Commercial results are in

Policy Updates

Hospital recognition: NTSV C-Section Rates

Administrative

Important reminder: Professional reimbursement policy update Scope of License

Reimbursement Policies

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Individual on and off exchange plans: 2019 benefit year update

Administrative

Integrated Care Model for plans purchased on the health insurance marketplace benefits patients and physicians

Administrative

Interactive Care Reviewer

Administrative

Introducing the new Clinical Criteria page for injectable, infused or implanted drugs

Pharmacy

Keep up with Medicare news

Medicare

Los Angeles Unified School District offers Medicare Advantage option

Medicare

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

MediConnect Plan network update

Cal MediConnect

Members’ rights and responsibilities

Policy Updates

Misrouted protected health information

Administrative

Need up to date pharmacy information?

Medi-Cal Managed Care

Network leasing arrangements

Administrative

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

Pharmacy information available on anthem.com/ca

Pharmacy

Practitioners’ rights during credentialing process

Medi-Cal Managed Care

Prior authorization requirements for Part B drug Nivestym

Cal MediConnect

Prior authorization requirements for subcutaneous implantable defibrillator system

Medi-Cal Managed Care

Provider Education seminars, webinars, workshops and more!

Administrative

Quarterly pharmacy formulary change

Medi-Cal Managed Care

Restructure of AIM advanced imaging clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Short and long acting narcotics regulatory changes and limits to days’ supplies

Cal MediConnect

Sign-up now for our Network eUPDATE today – it’s free!

Administrative

Timely access regulations and language assistance program

Products & Programs

Update to AIM clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Updated prior authorization form for providers

Medi-Cal Managed Care

Vaginal birth after cesarean certified shared decision making aid available on the web

Policy Updates

When and how to initiate Medicare Advantage reopenings

Medicare

Workers’ Compensation Physicians Acknowledgments required by California Code of Regulations §9767.5.1 Medical Provider Networks

Administrative
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