Ohio
Provider Communications

August 2021 Anthem Provider News - Ohio

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Title Category

Updates for specialty pharmacy are available - August 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Update: AIM Musculoskeletal Program effective November 1, 2021 - Site of care reviews*

*Notice of Material Amendment/Change to Contract (MAC)
Medical Policy & Clinical Guidelines

Transition to AIM Specialty Health imaging of the heart clinical appropriateness guideline for computed tomography to detect coronary artery calcification

Medical Policy & Clinical Guidelines

Telehealth visits can impact after hospitalization follow-up care for mental illness

Administrative

Specialty dose rounding program for certain oncology medications

Pharmacy

Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021

Pharmacy

Some requests to AIM may require documentation to support prior authorization

Products & Programs

Reimbursement policy update: Virtual Visits (Professional and Facility)*

*Notice of Material Amendment/Change to Contract (MAC)
Reimbursement Policies

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU*

*Notice of Material Amendment/Change to Contract (MAC)
Reimbursement Policies

Reimbursement policy update: Claims requiring additional documentation (Facility)*

*Notice of Material Amendment/Change to Contract (MAC)
Reimbursement Policies

Register now for our August CME webinars

Administrative

Preventing claims denials: Shingles vaccine

Medicare

Pharmacy information available at anthem.com

Pharmacy

New! Schedule appointments online through Availity

Digital Tools

Medicare News - August 2021

View these Medicare articles:
- Infliximab Step Therapy - Effective 7/15/2021
- Prior authorization requirement changes effective October 1, 2021 – UM AROW 1907
Medicare

Immune globulin adjusted body weight dosing program beginning August 1, 2021

Pharmacy

Clearing up coding confusion for retinal eye exams (DRE)

Administrative

Change in email submission of service requests for Federal Employee Program® members*

*Notice of Material Amendment/Change to Contract (MAC)
Federal Employee Plan (FEP)

Anthem to update formulary lists for commercial health plan pharmacy benefit effective October 1, 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy
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