New Hampshire
Provider Communications

June 2018 New Hampshire newsletter

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Title Category

AIM Musculoskeletal Program Clinical Appropriateness Guidelines updates

Products & Programs

Cervical Cancer Screening using Cytology and Human Papillomavirus Testing (CG-MED-43) not implemented

Reimbursement Policies

Claim processing update for services requiring AIM pre-service clinical review

Administrative

Clinical practice and preventive health guidelines available on anthem.com

Administrative

Cologuard covered for Medicare Advantage members

Medicare

Diagnosis-Related Group Newborn Inpatient Stays facility reimbursement policy update

Reimbursement Policies

Durable medical equipment miscellaneous code E1399 reminder

Administrative

Durable Medical Equipment professional reimbursement policy reminders

Reimbursement Policies

EDI collaboration with Availity effective June 1, 2018

Administrative

Escalation process document available

Administrative

Grievance and appeal update

Administrative

Individualized Care Program to support palliative care for commercial members

Products & Programs

Keep up with Medicare news

Medicare

Level of care pre-service clinical review drug list changes effective September 1, 2018

Administrative

MA home health network to be delegated to myNEXUS

Medicare

MCG Care Guidelines adopted for behavioral health services

Behavioral Health

Medical policy and clinical guidelines updates are available on anthem.com

Medical Policy & Clinical Guidelines

Medication adherence incentive offered to EPHC providers

Medicare

Member identification cards streamlined

Administrative

Misrouted protected health information (PHI)

Administrative

Motion Picture Industry Pension and Health Plans Offers Medicare Advantage Option

Medicare

Outpatient behavioral health therapy visits

Behavioral Health

Peer-to-peer process can help clarify clinical record

Medicare

Pharmacy information available on anthem.com

Pharmacy

Place of service claims processing mirrors CMS guidelines

Administrative

Pre-service clinical review drug list changes effective September 1, 2018

Administrative

Prior authorization requests for prescription medications accepted online

Pharmacy

Receive direct deposit of patient payments with Healthcare Bill Payments

Administrative

Review of reimbursement policies – professional

Reimbursement Policies

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

Administrative

Verifying eligibility for expanded hospice benefits

Administrative
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