Ohio
Provider Communications

March 2021 Anthem Provider News - Ohio

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Title Category

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - March 2021

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 attachment capability now includes itemized bills and more!

Administrative

Update: Notice of changes to the AIM Small Joint Surgery guideline

Medical Policy & Clinical Guidelines

Anthem clarifies guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)*

*Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Medicare News - March 2021

View these Medicare articles:
- MCG Care Guidelines 24th edition customization
- DME checklist of information needed from providers
Medicare

Access to more claim denial information is now self-service

Medicare

New provider directory indicator for telehealth services

Medicare

Medical policies and clinical utilization management guidelines update

Medicare

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021*

*Material Adverse Change (MAC)
Pharmacy

Updates for specialty pharmacy are available - March 2021*

*Material Adverse Change (MAC)
Pharmacy

Some HIV medication combinations may require prior authorization

Pharmacy

Claims editing update for ICD-10-CM Excludes 1 notes

Reimbursement Policies
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