Colorado
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

REMINDER: Expansion of AIM Musculoskeletal Program Effective November 1, 2020

October 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Oct 1, 2020

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines delayed

October 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Oct 1, 2020

AIM Specialty Health Clinical Guidelines update - Advanced Imaging (MAC)

Material Adverse Change (MAC)
July 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jul 1, 2019

New Clinical Guideline: Pneumatic Compression Devices, effective December 1, 2019 (MAC)

Material Adverse Change (MAC)
September 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Sep 1, 2019

Pre-Service/Prior Authorization Clinical Review Update -- September 2019 (MAC)

Material Adverse Change (MAC)
September 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Sep 1, 2019

Update to AIM Clinical Appropriateness Guidelines

December 2018 Anthem Provider Newsletter - CO Medical Policy & Clinical Guidelines Dec 1, 2018

Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

December 2018 Anthem Provider Newsletter - CO Medical Policy & Clinical Guidelines Dec 1, 2018

Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

December 2018 Anthem Provider Newsletter - CO Medical Policy & Clinical Guidelines Dec 1, 2018

AIM Specialty Health Clinical Guidelines update - Advanced Imaging of the Heart

October 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Oct 1, 2018

AIM Specialty Health Clinical Guidelines update – Radiation Oncology

October 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Oct 1, 2018

AIM Specialty Health Clinical Guidelines update - Sleep Disorder Management

October 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Oct 1, 2018

AIM Specialty Health Clinical Guidelines update -- Advanced Imaging of the Head and Neck

April 2019 Anthem Important Updates - Colorado Medical Policy & Clinical Guidelines Apr 1, 2019

AIM Specialty Health Clinical Guidelines update -- Advanced Imaging of the Heart

April 2019 Anthem Important Updates - Colorado Medical Policy & Clinical Guidelines Apr 1, 2019

AIM Specialty Health Clinical Guidelines update -- Musculoskeletal Joint Surgery

April 2019 Anthem Important Updates - Colorado Medical Policy & Clinical Guidelines Apr 1, 2019

AIM Specialty Health Clinical Guidelines update -- Sleep Disorder Management

April 2019 Anthem Important Updates - Colorado Medical Policy & Clinical Guidelines Apr 1, 2019

Pre-Service/Prior Authorization Clinical Review Update -- February 2020 (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Feb 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Musculoskeletal Program: Joint Surgery and Spine Surgery (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Feb 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging: Vascular Imaging (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Feb 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Feb 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
August 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Aug 1, 2020

Medical Record Standards

August 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Aug 1, 2020

Anthem customizations to MCG care guidelines 23rd edition (MAC)

Material Adverse Change (MAC)
August 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Aug 1, 2019

AIM Specialty Health Clinical Guidelines update - Advanced Imaging (MAC)

Material Adverse Change (MAC)
August 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Aug 1, 2019

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
August 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Aug 1, 2019

Updates to AIM Radiation Oncology: Proton Beam Therapy Clinical Appropriateness Guideline

August 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Aug 1, 2019

Updates to AIM Advanced Oncologic Imaging Clinical Appropriateness Guideline

August 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Aug 1, 2019

UPDATE: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and Setting determinations (MAC)

Material Adverse Change (MAC)
July 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Jul 1, 2020

New MCG 24th Edition Guidelines

July 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Jul 1, 2020

Medical Policy, Clinical UM Guidelines, and Pre-certification changes notification letter

August 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Aug 17, 2018

Update to AIM Advanced Imaging Clinical Guidelines

August 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Aug 17, 2018

Update to AIM Level of Care Musculoskeletal Surgery Clinical Guidelines

August 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Aug 17, 2018

Update to AIM Radiation Oncology Clinical Guidelines

August 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Aug 17, 2018

Medical Policy and Clinical UM Guideline changes notification letter

March 2019 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Mar 1, 2019

Medical Policy and Clinical UM Guidelines notification (MAC)

Material Adverse Change (MAC)
December 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Dec 1, 2019

Medical Policy, Clinical UM Guidelines, and Pre-certification changes notification letter

November 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Nov 1, 2018

Important Update: Milliman Care Guideline (MCG), 23rd Edition, Pelvic Organ Prolapse Repair (MAC)

Material Adverse Change (MAC)
January 2020 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jan 1, 2020

Dispatch Health: An extension of your team - Innovative On-demand Healthcare at Home

January 2020 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jan 1, 2020

Transition to AIM Clinical Appropriateness Guidelines -- Rehabilitative Services (MAC)

Material Adverse Change (MAC)
June 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Jun 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines May 1, 2020

AIM Specialty Health Clinical Guidelines update - Musculoskeletal Program

February 2019 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Feb 1, 2019

Medical Policy and Clinical UM Guidelines change notification letter

February 2019 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Feb 1, 2019

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines May 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Sleep Disorder Management (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines May 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- MSK Interventional Pain Management (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Musculoskeletal Program Joint Surgery Clinical Appropriateness Guidelines

May 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines May 1, 2020

Medical Policy and Clinical UM Guideline changes notification letter

January 2019 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Jan 1, 2019

MCG Care Guidelines 24th Edition (MAC)

Material Adverse Change (MAC)
April 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Apr 1, 2020

Clinical guideline update effective June 1, 2020 -- CG-SURG-92 / Paraesophageal Hernia Repair (MAC)

Material Adverse Change (MAC)
March 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Mar 1, 2020

Additional improvements coming to anthem.com regarding Medical Policies and Clinical Guidelines

November 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Nov 1, 2019

Important Update: Milliman Care Guideline (MCG), 23rd Edition, ORG -- W0163 Pelvic Organ Prolapse Repair

March 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Mar 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging of the Abdomen and Pelvis (MAC)

Material Adverse Change (MAC)
November 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Nov 1, 2019

AIM Specialty Health Clinical Appropriateness Guidelines update -- Radiation Therapy (MAC)

Material Adverse Change (MAC)
November 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Nov 1, 2019

AIM Specialty Health Clinical Appropriateness Guidelines update -- Musculoskeletal Program Spine Surgery (MAC)

Material Adverse Change (MAC)
November 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline

November 2019 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Nov 1, 2019

Medical Policy, Clinical UM Guidelines, and Pre-certification changes notification letter

September 2018 Anthem Important Updates - CO Medical Policy & Clinical Guidelines Aug 31, 2018

MCG care guidelines 23rd Edition and Anthem customizations

May 2019 Anthem Important Updates - Colorado Medical Policy & Clinical Guidelines May 1, 2019

Medical Policy and Clinical UM Guidelines notification letter

June 2019 Anthem Important Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2019

Laboratory and Venipuncture Services (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
October 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Oct 1, 2020

Reimbursement policy update -- Claims Requiring Additional Documentation policy (Facility)

October 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Oct 1, 2020

Assistant Surgery Services/Code List policy update - Professional

October 2018 Anthem Provider Newsletter - CO Reimbursement Policies Oct 1, 2018

Reimbursement Policies are available online

October 2018 Anthem Provider Newsletter - CO Reimbursement Policies Oct 1, 2018

Clear Claim Connection

October 2018 Anthem Provider Newsletter - CO Reimbursement Policies Oct 1, 2018

Maternity Services and Multiple Delivery (Professional Reimbursement Policies – New) (MAC)

Material Adverse Change (MAC)
September 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2019

Intensity Modulated Radiation Therapy Planning and Delivery (Professional Reimbursement Policy – New) (MAC)

Material Adverse Change (MAC)
September 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2019

Claim editing update for Excludes1 notes

September 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2019

Claims requiring additional documentation facility reimbursement policy update

September 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2019

Reimbursement for Convenience Surgical Supply Kits - Professional

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

CORRECTION: Notice regarding post-pay review of ER claims

CORRECTION: Notice regarding post-pay review of ER claims - Colorado Reimbursement Policies May 16, 2019

Scope of License - Reimbursement Policy Update (Professional)

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

“Rule of Eight” Reporting Guidelines for Physical Medicine and Rehabilitation Services - Professional

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

System updates for reimbursement policies in 2019 - Professional

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period - Professional

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

Reimbursement Policies are available online

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

Partial Hospitalization and Intensive Outpatient Program Services (Facility Reimbursement Policy - New)

April 2019 Anthem Important Updates - Colorado Reimbursement Policies Apr 1, 2019

Clear Claim Connection

December 2018 Anthem Provider Newsletter - CO Reimbursement Policies Dec 1, 2018

Clinical Laboratory Improvement Amendments (CLIA) claim requirements effective May 1, 2020 (MAC)

Material Adverse Change (MAC)
February 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Feb 1, 2020

Professional Reimbursement Policy Change and supporting claims editing notification for CMS-1500 submitters

December 2018 Anthem Important Updates - CO Reimbursement Policies Dec 1, 2018

Reimbursement policy update -- Claims Requiring Additional Documentation (Facility)

August 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Aug 1, 2020

Bundled Services (Professional Reimbursement Policy - Update) (MAC)

Material Adverse Change (MAC)
August 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Aug 1, 2019

Frequency Editing (Professional Reimbursement Policy - Update) (MAC)

Material Adverse Change (MAC)
August 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Aug 1, 2019

Modifier 79 reminder: Professional

July 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2019

Modifier 63 reminder: Professional

July 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2019

ICD-10-CM Coding Guidelines and Laterality: Professional

July 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2019

System updates for 2020 (Professional)

December 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Dec 1, 2019

New Reimbursement Policies (Professional): Durable Medical Equipment - Rent to Purchase and Durable Medical Equipment - Modifiers

December 2019 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Dec 1, 2019

Outpatient facility edit implementation effective April 26, 2020 (MAC)

Material Adverse Change (MAC)
January 2020 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jan 1, 2020

Body Mass Index (BMI) (Facility Reimbursement Policy - Update)

February 2019 Anthem Important Updates - CO Reimbursement Policies Feb 1, 2019

Professional Reimbursement Policy Change and supporting claims editing notification for CMS-1500 submitters

February 2019 Anthem Important Updates - CO Reimbursement Policies Feb 1, 2019

Nurse Practitioner and Physician Assistant Service (Professional Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
June 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jun 1, 2020

Claims requiring additional documentation (Facility Reimbursement Policy -- Update for Outpatient) (MAC)

Material Adverse Change (MAC)
May 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies May 1, 2020

Bundled Services and Supplies – Professional

August 2018 Anthem Provider Newsletter - CO Reimbursement Policies Aug 17, 2018

Once per Lifetime Procedures – Professional

August 2018 Anthem Provider Newsletter - CO Reimbursement Policies Aug 17, 2018

Reminder about System Updates

May 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies May 1, 2020

Reimbursement Policies are available online

August 2018 Anthem Provider Newsletter - CO Reimbursement Policies Aug 17, 2018

Clear Claim Connection

August 2018 Anthem Provider Newsletter - CO Reimbursement Policies Aug 17, 2018

Update regarding evaluation and management with modifier 25 same day as procedure when a prior E/M for the same or similar service has occurred (Professional)

February 2019 Anthem Provider Newsletter - CO Reimbursement Policies Feb 1, 2019

Significant Edits (Professional)

February 2019 Anthem Provider Newsletter - CO Reimbursement Policies Feb 1, 2019

Reminder: Review ICD-10-CM Coding Guidelines (Professional)

February 2019 Anthem Provider Newsletter - CO Reimbursement Policies Feb 1, 2019

Reimbursement Policies are available online

February 2019 Anthem Provider Newsletter - CO Reimbursement Policies Feb 1, 2019

Clear Claim Connection: our web-based claim edit tool

February 2019 Anthem Provider Newsletter - CO Reimbursement Policies Feb 1, 2019
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