Ohio
Provider Communications

April 2019 Anthem Provider Newsletter - Ohio

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Title Category

New on Interactive Care Reviewer (ICR): Request Clinical Appeals

Administrative

UM Process Change: Courtesy approval determination notifications

Administrative

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Accurate coding helps provide a comprehensive picture of patients’ health and services provided

Administrative

Why do patients stop taking their prescribed medications and what can you do to help them?

Administrative

The 2019 Provider Manual is now available for your review

Administrative

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes: April 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
Administrative

Medical Policy and Clinical Guidelines Updates - April 2019*

Medical Policy & Clinical Guidelines

Update to AIM Advanced Imaging of the Heart Clinical Appropriateness Guideline*

Medical Policy & Clinical Guidelines

Update to AIM Advanced Imaging of the Head and Neck Clinical Appropriateness Guidelines*

Medical Policy & Clinical Guidelines

Update to AIM Musculoskeletal Joint Surgery Clinical Appropriateness Guidelines*

Medical Policy & Clinical Guidelines

Update to AIM Sleep Disorder Management Clinical Appropriateness Guidelines*

Medical Policy & Clinical Guidelines

Update regarding evaluation and management with modifier 25

Medicare

Coming soon: Reimbursement for select HEDIS-related CPT II codes for Medicare Advantage members

Medicare

Keep up with Medicare news - April 2019

Medicare

Anthem expands specialty pharmacy prior authorization list*

Pharmacy

Pharmacy information available at anthem.com

Pharmacy

New AIM Rehabilitative program effective July 1, 2019

Products & Programs

New Reimbursement Policy: Partial Hospitalization Program and Intensive Outpatient Program Services Facility*

Reimbursement Policies
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