Ohio
Provider Communications

Articles

Title Publication Category Date

Medicare News - October 2020

View these Medicare articles:
- Evaluation and management services correct coding
- Medical policies and clinical utilization management guidelines update
- Prior authorization requirements for the below codes effective January 2021
October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Medical drug benefit clinical criteria updates

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Prior authorization requirements for the below codes effective January 1, 2021

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Social determinants of health support expanding with GroundGame Health

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Provider transparency update

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - October 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.
October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

New Blue HPN® network included in plans available for employee open enrollment Fall 2020

October 2020 Anthem Provider News - Ohio Products & Programs Oct 1, 2020

Updated Provider Manual now available*

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

Patient360 enhancement for medical providers

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - September 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.
September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Inclusion of AIM-reviewed services in UM reimbursement penalties

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020*

September 2020 Anthem Provider News - Ohio Products & Programs Sep 1, 2020

Meet your Cancer Care Navigator

Anthem’s new cancer support program helps improve outcomes while easing burdens for you and your patients.
September 2020 Anthem Provider News - Ohio Products & Programs Sep 1, 2020

Predictive analytics guide proactive support to patients undergoing chemotherapy resulting in lowered admissions

September 2020 Anthem Provider News - Ohio Products & Programs Sep 1, 2020

Anthem to update formulary lists for commercial health plan pharmacy benefit

September 2020 Anthem Provider News - Ohio Pharmacy Sep 1, 2020

Specialty pharmacy updates are available - September 2020*

September 2020 Anthem Provider News - Ohio Pharmacy Sep 1, 2020

New provider directory indicators for medication assisted treatment (MAT) providers

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

EDI Gateway migration deadline is September 15, 2020

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Providers can now receive and respond to medical record requests for post-pay audit via Change Healthcare’s Assurance Attach Assist Module

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Enhanced medical records submission process to support claims processing

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Patient360 adds care gap alert feedback for medical providers

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Prospective Program continues

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Reimbursement policy update: Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)*

September 2020 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2020

Reimbursement policy update: Frequency Editing (Professional)*

September 2020 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2020

Update: Notice of changes to the AIM musculoskeletal program

September 2020 Anthem Provider News - Ohio Medicare Sep 1, 2020

Medical drug benefit clinical criteria updates

September 2020 Anthem Provider News - Ohio Medicare Sep 1, 2020

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)*
August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Anthem to update formulary lists for commercial health plan pharmacy benefit

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

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

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

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

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

Pharmacy information available on anthem.com

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

Provider contract and fee schedule notifications coming soon

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Resources to support diverse patients and communities

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Evaluation and management services correct coding (Professional)

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Migrate your EDI transactions to Availity today

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Electronic claims submission - Clinical Laboratory Improvement Amendments (CLIA)

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Anthem electronic attachments - X12 275 5010

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

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

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Medical record standards

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Appropriate coding helps provide a comprehensive picture of patients’ health

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Medical policy and clinical guideline updates - August 2020*

August 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2020

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

August 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2020

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

August 2020 Anthem Provider News - Ohio Reimbursement Policies Aug 1, 2020

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
August 2020 Anthem Provider News - Ohio Medicare Aug 1, 2020

Medical drug benefit clinical criteria updates

August 2020 Anthem Provider News - Ohio Medicare Aug 1, 2020

2020 Medicare risk adjustment provider trainings

August 2020 Anthem Provider News - Ohio Medicare Aug 1, 2020

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.
July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

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

July 2020 Anthem Provider News - Ohio Products & Programs Jul 1, 2020

Updated coverage for HIV PrEP medications

July 2020 Anthem Provider News - Ohio Pharmacy Jul 1, 2020

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

July 2020 Anthem Provider News - Ohio Pharmacy Jul 1, 2020

Important change to prior authorization requests for inpatient hospital admissions*

July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

Welcome to the Custom Learning Center in Availity

July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

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

July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

New MCG 24th Edition Guidelines

July 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2020

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

July 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2020

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

July 2020 Anthem Provider News - Ohio Federal Employee Plan (FEP) Jul 1, 2020

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
July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

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

July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

2020 affirmative statement concerning utilization management decisions

July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

Medical drug benefit clinical criteria updates

July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

In-Office Assessment Program

July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

2020 Special Needs Plans

July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

Webinar recording now available for providers on how to leverage telehealth to care for Behavioral Health patients during COVID-19 and beyond

Anthem hosted a provider webinar to share information and resources with Behavioral Health providers to assist with maximizing the telehealth experience.  Access the webinar recording to learn more about leveraging telehealth for behavioral health services.
COVID-19 Information - Ohio Behavioral Health Jun 25, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - June 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.
June 2020 Anthem Provider News - Ohio Administrative Jun 1, 2020

UPDATE: New Level of Care Medical Necessity Review of Upper and Lower Endoscopy procedures is delayed

June 2020 Anthem Provider News - Ohio Products & Programs Jun 1, 2020

A special thank you to Care Providers

Thank you for your tireless efforts in keeping our country healthy. For all you do, we would like to share a message of our gratitude.
COVID-19 Information - Ohio Administrative Jun 1, 2020

Quality Corner: Follow-Up after Hospitalization for Mental Illness

June 2020 Anthem Provider News - Ohio Behavioral Health Jun 1, 2020

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

June 2020 Anthem Provider News - Ohio Pharmacy Jun 1, 2020

Reminder: Anthem requires National Drug Code for professional and facility outpatient claims effective June 15, 2020*

June 2020 Anthem Provider News - Ohio Pharmacy Jun 1, 2020

Pharmacy information available at anthem.com

June 2020 Anthem Provider News - Ohio Pharmacy Jun 1, 2020

Anthem introduces lower cost Anthem Health Access Plans on June 1 in response to COVID-19 crisis

June 2020 Anthem Provider News - Ohio Administrative Jun 1, 2020

Anthem Commercial Risk Adjustment (CRA) Program Update: Retrospective Program Begins; Prospective Program Continues

June 2020 Anthem Provider News - Ohio Administrative Jun 1, 2020

Availity Portal Notification Center

June 2020 Anthem Provider News - Ohio Administrative Jun 1, 2020

Quality Corner: CPT® Category II Codes - Collaborating for enhanced patient care

June 2020 Anthem Provider News - Ohio Administrative Jun 1, 2020

Medical Policy and Clinical Guideline Updates - June 2020*

June 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines*

June 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2020

REMINDER: AIM Rehabilitative Program Pediatric Exclusions

June 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2020

New Reimbursement Policies: Nurse Practitioner and Physician Assistant Services (Professional)*

June 2020 Anthem Provider News - Ohio Reimbursement Policies Jun 1, 2020

Medicare News - June 2020

View these Medicare articles:
- Acquisition of Beacon Health Options
- MCG care guidelines – 24th edition
June 2020 Anthem Provider News - Ohio Medicare Jun 1, 2020

2020 Medicare risk adjustment provider trainings

June 2020 Anthem Provider News - Ohio Medicare Jun 1, 2020

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline

June 2020 Anthem Provider News - Ohio Medicare Jun 1, 2020

Anthem Blue Cross and Blue Shield (Anthem) working with Optum to collect medical records for risk adjustment

June 2020 Anthem Provider News - Ohio Medicare Jun 1, 2020

Modifier use reminders

June 2020 Anthem Provider News - Ohio Medicare Jun 1, 2020

Diabetes HbA1c < 8 HEDIS guidance

June 2020 Anthem Provider News - Ohio Medicare Jun 1, 2020

Anthem waives cost share for COVID-19 treatment (Updated May 29, 2020)

Effective April 1, we expanded coverage for our members undergoing treatment related to a COVID-19 diagnosis, which covers the waiver of cost shares for COVID-19 treatment received through December 31, 2020.
COVID-19 Information - Ohio Administrative May 29, 2020

Introducing lower cost Anthem Health Access Plans on June 1 in response to COVID-19 crisis

Beginning June 1, 2020, Anthem is introducing our Anthem Health Access Plans for certain large group employers currently enrolled in our commercial lines of business only.
COVID-19 Information - Ohio Administrative May 26, 2020

Webinar recording now available for network providers on SBA loans and other federal relief programs in response to COVID-19 (Updated May 1, 2020)

Anthem hosted a provider webinar to share information and resources with its network providers regarding opportunities providers have to access loans through the U.S Small Business Administration (SBA) and other federal programs in response to the economic impact of COVID-19. Access the webinar recording using the password “health” to learn more about federal financial relief for providers.
COVID-19 Information - Ohio Administrative May 1, 2020

COVID-19 information repository for Anthem Care Providers

May 2020 Anthem Provider News - Ohio Administrative May 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - May 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.
May 2020 Anthem Provider News - Ohio Administrative May 1, 2020

The 2020 Provider Manual is now available

May 2020 Anthem Provider News - Ohio Administrative May 1, 2020

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

May 2020 Anthem Provider News - Ohio Pharmacy May 1, 2020

Anthem Commercial Risk Adjustment (CRA) Prospective Program Update: Assessing Your Patients for Risk Adjustable Conditions

May 2020 Anthem Provider News - Ohio Administrative May 1, 2020

Quality Corner: Diabetes HbA1c<8 HEDIS Guidance

May 2020 Anthem Provider News - Ohio Administrative May 1, 2020

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM MSK Interventional Pain Management Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Musculoskeletal Program Joint Surgery Clinical Appropriateness Guidelines*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

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

May 2020 Anthem Provider News - Ohio Reimbursement Policies May 1, 2020

Reminder about system updates

May 2020 Anthem Provider News - Ohio Reimbursement Policies May 1, 2020

Medicare News - May 2020

View these Medicare articles:
- Prior Authorization requirements
- New behavioral health Medicare Advantage individual and Group Retiree Solutions provider fax
May 2020 Anthem Provider News - Ohio Medicare May 1, 2020
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