Colorado
Provider Communications

July 2021 Anthem Provider News and Important Updates - Colorado

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Title Category

Another mark of the pandemic: An increase in childhood obesity

More potato chips, sugary drinks and less physical activity are key contributors

Administrative

Anthem prior authorization updates for specialty pharmacy are available (MAC)

Material Adverse Change (MAC)
Pharmacy

Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross and Blue Shield results in improved care management for patients

Medicare

Certain specialty medication precertification requests may require additional documentation

Pharmacy

Clinical quality in practice: CME webinar series

Administrative

Company to retire Blue Precision program at the end of the year

Administrative

Drug fee schedule update

Administrative

Electronic claim response files

Digital Tools

How to enroll in electronic fund transfer for faster remittance

Digital Tools

Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual

Material Adverse Change (MAC)
Administrative

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Digital Tools

Let’s vaccinate

Help increase your vaccination rates and close gaps-in-care with these tools and strategies

Medicare

Medical drug benefit clinical criteria updates

Medicare

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Medicare

New reimbursement policy: Non-patient laboratory services - facility (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Pre-Service / Prior Authorization Clinical Review Update: July 2021 (MAC)

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

Medicare

Prior authorization requirement changes effective September 1, 2021 – UM AROW 1845

Medicare

Proper coding for in-home monitoring can make a measurable difference for INR

Administrative

Reimbursement policy reminder: Inpatient readmissions

Medicare

Reminder: Back pain guide program, effective July 19, 2021

Products & Programs

Reminder: Updated AIM rehabilitative program, effective August 1, 2021 – and site of service reviews

Products & Programs

Site-of-Care medical necessity reviews for long-acting colony-stimulating factors will not be implemented on August 1, 2021 (MAC)

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Timely receipt of the primary payer’s EOB can help reduce timely filing denials for secondary claims

Administrative

Updates to the AIM advanced imaging clinical appropriateness guidelines

Medicare

Working with Anthem webinars – July 2021 schedule: Anthem networks overview

Administrative
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