Ohio
Provider Communications

December 2018 Anthem Ohio Provider Newsletter

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Title Category

When and how to initiate Medicare Advantage reopenings

Medicare

View reimbursement policies online at anthem.com

Reimbursement Policies

Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web

Administrative

Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines

Update to AIM Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines

Upcoming Changes for Automotive Accounts

Products & Programs

Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines

Reimbursement Policy Updates - December 2018

Reimbursement Policies

Reimbursement Policy Update - Scope of License (Professional)

Reimbursement Policies

Reimbursement for Convenience Surgical Supply Kits: Professional

Reimbursement Policies

Pharmacy Information Available at anthem.com

Pharmacy

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - December 2018

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

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

Members’ Rights and Responsibilities

Administrative

Members with COPD eligible for health improvement program

Medicare

Members Can Shop for Cost-Efficient Health Care Using SmartShopper

Administrative

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

Medical Polices and Clinical Guidelines Updates - December 2018

Medical Policy & Clinical Guidelines

Keep up with Medicare news

Medicare

Introducing the New Clinical Criteria Page for Injectable, Infused or Implanted Drugs

Pharmacy

Interactive Care Reviewer (ICR) New Features

Coverage and Clinical Guidelines

Integrated Care Model for Plans Purchased on the Health Insurance Marketplace Benefits Patients and Physicians

Administrative

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Important Information about Utilization Management

Administrative

HEDIS® 2018 Commercial Results Are In

Administrative

GM Precertification and Integrated Health Management (360 Health) changes for CY 2019

Products & Programs

Coordination of Care

Administrative

Coordination of Benefits for an FEP® member

Federal Employee Plan (FEP)

ConditionCare Program Benefits Patients and Physicians

Administrative

CMS Medicare Preclusion List effective April 1, 2019

Medicare

Clinical practice and preventive health guidelines available on anthem.com

Medical Policy & Clinical Guidelines

Case Management Program

Administrative

Bundled Services and Supplies (Professional)

Reimbursement Policies

Benefit change for Infliximab for Federal Employee Program (FEP)

Federal Employee Plan (FEP)

Availity to Serve as EDI Entry Point for Electronic Submissions

Administrative

Anthem Works to Simplify Payment Recovery Process for National Accounts Membership

Administrative

Anthem to Enhance Claim Edits for Outpatient Facility Claims

Administrative

Anthem Streamlines Member ID Cards - Use Availity to Verify Members' Cost Shares and Benefits at Time of Service

Administrative

Anthem MA Ohio Field Based Case Management Program

Medicare

Anthem Accepts Electronic Prior Authorization Requests for Prescription Medications Online

Pharmacy

2019 Medicare Advantage individual benefits and formularies

Medicare

2019 FEP Benefit information available online

Federal Employee Plan (FEP)
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