Ohio
Provider Communications

August 2020 Anthem Provider News - Ohio

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Title Category

2020 Medicare risk adjustment provider trainings

Medicare

Anthem electronic attachments - X12 275 5010

Administrative

Anthem prior authorization updates for specialty pharmacy are available - August 2020*

Pharmacy

Anthem to update formulary lists for commercial health plan pharmacy benefit

Pharmacy

Appropriate coding helps provide a comprehensive picture of patients’ health

Administrative

Coming soon: Enhance your prior authorization and inpatient admission and discharge notification via electronic and digital self-service for 2020

Administrative

Electronic claims submission - Clinical Laboratory Improvement Amendments (CLIA)

Administrative

Evaluation and management services correct coding (Professional)

Administrative

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

Medical Policy & Clinical Guidelines

Medical drug benefit clinical criteria updates

Medicare

Medical policy and clinical guideline updates - August 2020*

Medical Policy & Clinical Guidelines

Medical record standards

Administrative

Medicare News - August 2020

View these Medicare articles:
- Submit behavioral health authorizations via our online Interactive Care Reviewer (ICR) tool
- Updates to AIM musculoskeletal program clinical appropriateness guidelines
- Provider data update
- Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM
- AIM Musculoskeletal program expansion
- New MCG Care Guidelines 24th edition
Medicare

Migrate your EDI transactions to Availity today

Administrative

Notice of material changes/amendments to contract and prior authorization changes - August 2020

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.
- Anthem prior authorization updates for specialty pharmacy are available-August 2020*
- Medical Policy and Clinical Guideline Updates-August 2020*
- Expansion of AIM Musculoskeletal Program effective November 1, 2020*
- Reimbursement Policy Update: Claims requiring additional documentation (Facility)*
Administrative

Pharmacy information available on anthem.com

Pharmacy

Provider contract and fee schedule notifications coming soon

Administrative

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

Reimbursement Policies

Resources to support diverse patients and communities

Administrative

Voluntary site of care outreach for oncology checkpoint inhibitors beginning August 1, 2020

Pharmacy
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