Ohio
Provider Communications

July 2020 Anthem Provider News - Ohio

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Title Category

2020 affirmative statement concerning utilization management decisions

Medicare

2020 Special Needs Plans

Medicare

Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members

Federal Employee Plan (FEP)

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Program Year Progression - What’s in it for you and your patients?

Administrative

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

Pharmacy

Important change to prior authorization requests for inpatient hospital admissions*

Administrative

In-Office Assessment Program

Medicare

Medical drug benefit clinical criteria updates

Medicare

Medicare News - July 2020

View these Medicare articles:
- New behavioral health discharge call-in line
- Medical policies and clinical utilization management guidelines update
- Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines
- Transition to AIM rehabilitative services clinical appropriateness guidelines
- Modifier use reminders
Medicare

New MCG 24th Edition Guidelines

Medical Policy & Clinical Guidelines

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - July 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.
Administrative

Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

Medicare

Update: New go-live date for level of care medical necessity review of upper and lower endoscopy procedures

Products & Programs

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations*

Medical Policy & Clinical Guidelines

Updated coverage for HIV PrEP medications

Pharmacy

Welcome to the Custom Learning Center in Availity

Administrative
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