Georgia
Provider Communications

July 2021 Anthem Provider News - Georgia

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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

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

Medicare Advantage
Medicare

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

Medicare Advantage
Medicare

Back pain guide program effective July 19, 2021

Products & Programs

Certain specialty medication precertification requests may require additional documentation

Pharmacy

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

Products & Programs

Continuing Medical Education (CME) webinar series

Administrative

Designated specialty pharmacy network updates

Material adverse change (MAC)
Pharmacy

Electronic claim response files

Digital Tools

Georgia Anthem preapproval list change notification 7/1/2021

Material adverse change (MAC)
Policy Updates

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

Digital Tools

June 2021 updates for specialty pharmacy are available

Material adverse change (MAC)
Pharmacy

Keep up with Medicare news

Medicare Advantage
Medicare

Let’s Vaccinate

Medicare Advantage: Help increase your vaccination rates and close gaps-in-care with these tools and strategies.
Medicare

March 2021 medical drug benefit clinical criteria updates

Medicare Advantage
Medicare

Medical policy and clinical guideline updates 7/1/2021

Medical Policy & Clinical Guidelines

New reimbursement policy: modifier 90: reference (outside) laboratory and pass-through billing

Medicare Advantage
Medicare

New reimbursement policy: Non-Patient Laboratory Services (facility)

Material adverse change (MAC)
Reimbursement Policies

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

Medicare Advantage
Medicare

Proper coding for in-home monitoring can make a measurable difference for international normalized ratio

Administrative

Reimbursement policy update: Consultations (professional)

Material adverse change (MAC)
Reimbursement Policies

REMINDER: Updated AIM rehabilitative program effective August 1, 2021 for site of service reviews

Products & Programs

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

We want to help.
Administrative

Update: site of care medical necessity reviews for long-acting colony-stimulating factors will no longer go into effect on August 1, 2021

Material adverse change (MAC)
Pharmacy
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