California
Provider Communications

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Keep up with Medicare news – January 2022

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update
• Medical step therapy updates
• Anthem Blue Cross expands specialty pharmacy precertification list

Important update on Botox® for Medicare members of Anthem Blue Cross

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Anthem Blue Cross expands specialty pharmacy precertification list

Keep up with Cal MediConnect news - January 2022

• Medical step therapy updates

Anthem Blue Cross is transitioning to the Availity Authorization App

Availity Authorization App improvements based on your feedback

Reminder: EnrollSafe is available: electronic funds transfer enrollment portal for Anthem Blue Cross providers

Update: Anthem Blue Cross to implement provider claim payment dispute process for Commercial lines of business has been delayed

Professional system updates for 2022

Outpatient system updates for 2022

Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date

2022 EPO and HMO individual on and off exchange products, and the expansion of EPO in new regions

Importance of PCP after-hours messaging

Once-a-year testing is critically important to providing quality diabetes care

Physicians and clinical care teams: Study finds imaging for lower back pain does not improve outcomes

Chlamydia is asymptomatic. Only through screening will we know for sure

Case Management Program

Contract compliance with accessibility standards for Appointment Availability and Emergency Care instructions After Hours Care

Member rights and responsibilities

Coordination of care

Clinical practice and preventive health guidelines available on anthem.com/ca

Medical necessity review process overview

Appropriate 911/emergency care procedures

Submitting prior authorizations is getting easier

Anthem Blue Cross is transitioning to the Availity Authorization app

Provider directory and provider data updates

Provider education

Network leasing arrangements

Is prior authorization required?

Reminder: EnrollSafe is available – electronic funds transfer enrollment portal for Anthem Blue Cross providers

EnrollSafe replaced CAQH Enrollhub effective November 1, 2021

RETRACTION: Inpatient Facility Transfers – reimbursement policy (facility)

Reimbursement policy update: Virtual Visits - professional and facility

Keep your contact information current

Contract compliance with accessibility standards for Appointment Availability and Emergency Care instructions After Hours Care

Overlapping service areas

Where and how to submit BlueCard® claims

BlueCard Program quick tips

Practice status: Open or closed

Pharmacy information available on Anthem.com/ca

Benefit plan updates effective January 1, 2022

Provider Notification of Benefit Change for CalPERS PPO Members‐ bevacizumab (Avastin), epoetin alfa (Epogen and Procrit), filgrastim (Neupogen), pegfilgrastim (Neulasta), rituximab (Rituxan), and trastuzumab (Herceptin)

Good news: Non-payment remittance advice enhancements are here

Policy update: Drug screen testing

Policy update: Drug screen testing, effective March 1, 2022

Submitting prior authorizations is getting easier

Keep up with Medi-Cal news – December 2021

• Durable medical equipment prior authorization requirement changes effective February 1, 2021

• Prior authorization requirement changes

• Medical drug benefit Clinical Criteria updates

• Managed care organization pharmacy benefits transitioning to the Medi-Cal Rx program

• Medical Policies and Clinical Utilization Management Guidelines update

Policy update: Drug screen testing

Policy update: Drug screen testing, effective March 1, 2022

Updates to AIM Specialty Health Advanced imaging clinical appropriateness guidelines

2022 Medicare Advantage services area and benefit updates

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

Submitting prior authorizations is getting easier

Keep up with Medicare news – December 2021

• Updates to AIM Specialty Health musculoskeletal interventional pain management clinical appropriateness guideline
• Medical drug benefit Clinical Criteria updates
• Protocol for providers serving members with hearing aid coverage administered by Hearing Care Solutions
• New York City Medicare Advantage announcement
• Medical Policies and Clinical Utilization Management Guidelines update
• Medical Policies and Clinical Utilization Management Guidelines update

Policy update: Drug screen testing

Policy update: Drug screen testing, effective March 1, 2022

Keep up with Cal MediConnect news - December 2021

• Medical Policies and Clinical Utilization Management Guidelines update
• Medical drug benefit Clinical Criteria updates

Grief and Loss Forum

Join us to hear from a diverse panel of experienced Motivo and Anthem Blue Cross professionals about the disproportionate impact of the pandemic on communities of color.

Action Required: 2021 Member Grievance and Appeals Attestation Requirement

Provider claim payment disputes for Anthem Blue Cross’ Commercial lines of business

Provider transparency update

Anthem Blue Cross cost transparency

Include referring provider name and NPI on home infusion therapy and ambulatory infusion suite professional claims

Update regarding annual wellness visits for ACA-compliant health plans

Time to prepare for HEDIS® medical record review

Reducing the burden of medical record review and improving health outcomes with HEDIS® ECDS reporting

CME credits available in 2021 for a variety of clinical quality webinars – register now!

Join Anthem Blue Cross in talking about racism and its impact on health and earn continuing education credits!

Avoid claim denials: VYNE medical attachment program has expired

Advise clearinghouses we no longer accept attachments through this vendor to avoid claim denials.

Be antibiotics aware: Protect your patient

Surprisingly easy ways to help patients quit smoking cigarettes

Change in coverage for continuous glucose monitors for some fully insured groups

Against medical advice (AMA) discharge physician tracking tool

EnrollSafe is available: Our new electronic funds transfer enrollment portal for Anthem Blue Cross providers

EnrollSafe replaces CAQH Enrollhub effective November 1, 2021

Important update on Botox® for Anthem Blue Cross members

BlueHPN to expand in California for 2022

Discharges against medical advice

4 things you can do to encourage cancer screenings for your women patients

Electronic data interchange process

Claims editing update for ICD-10-CM Excludes 1 notes

Clinical criteria updates

Unspecified diagnosis reminder

Pharmacy services to be fee-for-service benefit

New York City Medicare Advantage announcement

Updates to AIM Specialty Health cardiology clinical appropriateness guidelines

Clinical criteria updates

Anthem Blue Cross offering Advance Medical Directives program for 2022

Anthem Blue Cross Medicare Advantage FFS HMO network guidance

Electronic data interchange process

Keep up with Medicare news – November 2021

• Anthem Blue Cross expands specialty pharmacy precertification list

Claims editing update for ICD-10-CME Excludes 1 notes

Clinical criteria updates

Keep up with Cal MediConnect news November 2021

• Anthem Blue Cross expands specialty pharmacy precertification list

Join The Fenway Institute for a CME webinar about improving your LGBTQIA+ patient interactions

Join a live webinar, “LGBTQIA+ Care: Delivering Trust and Belonging with Every Interaction,” presented by the National LGBTQIA+ Health Education Center at The Fenway Institute. 

New Medicare Advantage plan will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing Providers Nationally

Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees across the United States will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan and have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing. Read important information about this change in the New York City Medicare Advantage announcement.

Join the American Heart Association for a CME webinar on hypertension and diabetes disease management

Chronic disease management strategies for your patients with hypertension and diabetes
Date: Friday, October 8, 2021
Time: 12:00 p.m. ET

New specialty pharmacy medical step therapy requirements

Get your payments faster when you sign up for electronic funds transfer

Keep up with Cal MediConnect news October 2021

• May 2021 Medical Policies and Utilization Management Guidelines update

• 2021 affirmative statement concerning utilization management decisions

Federal Price Transparency and Consolidated Appropriations Act phase in new mandates beginning January 1, 2022

Clarification: Anthem’s enhanced claim edits for outpatient facility claims

For 2022, Anthem Blue Cross continues to offer EPO and HMO Individual on and off exchange products, and is excited to announce the expansion of the EPO offerings to new regions

Your recommendation is key to encouraging cancer screenings for your female patients

Good news! Non-payment remittance advice enhancements coming soon