California
Provider Communications

Clearing up-coding confusion for retinal eye exams (DRE)

Register now for our August CME webinars!

Schedule appointments online through Availity

Specialty dose rounding program for certain oncology medications

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

Anthem Blue Cross to update formulary lists for commercial health plan pharmacy benefit, October 1, 2021

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

Pharmacy information available on anthem.com/ca

Reimbursement policy update: Claims requiring additional documentation (facility)

Preventing claims denials: Shingles vaccine

Know best: Shingles vaccinations are a Medicare Part D benefit whether administered in your office or in the pharmacy.

Prior authorization requirement changes effective October 1, 2021 – UM AROW 1907

Infliximab Step Therapy – effective July 15, 2021

Member grievance and appeals attestation requirement

Participating providers are required to acknowledge (annually) that Member Grievance and Appeals forms, a description of grievance procedures, and assistance in filing grievances are readily available at each contracted provider location(s).

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

Reductions in missed appointments are significant.

Help for members impacted by wildfires in California

Register for upcoming August CME webinars

Motivating Patients to Adhere to Cervical Cancer Prevention and Screening Recommendations
Tuesday, August 3, 2021, 12:00 p.m. ET

10 Best Practices for Improving Pharmacy Quality Measures
Thursday, August 12, 2021, 1:00 p.m. or 3:00 p.m. ET

6 Ways to Improve Risk Adjustment Documentation Accuracy
Tuesday, August 17, 2021, 12:00 p.m. or 3:00 p.m. ET

Register Now!

Clinical quality in practice: CME webinar series

Timely receipt of the primary payer’s EOB can help reduce timely filing denials for secondary claims

Proper coding for in-home monitoring can make a measurable difference for INR

Medical practices – are you keeping something from us

Another mark of the pandemic: An increase in childhood obesity

How to enroll in electronic fund transfer for faster remittance

Electronic claim response files

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Overlapping service areas

Where and how to submit BlueCard claims

BlueCard® program quick tips

Practice status: open or closed

Certain specialty medication precertification requests may require additional documentation

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross results in improved care management for patients

Coding spotlight: Mental disorders in childhood

What matters most: Improving the patient experience

Resources to support your diverse patient panel

Infusion step therapy retraction notice

Specialty pharmacy prior authorization retraction notice

February 2021 medical policies and utilization management guidelines update

Prior authorization requirement changes effective September 1, 2021 – UM AROW 1327

Certain specialty medication precertification requests may require additional documentation

Let’s vaccinate

Prior authorization requirement changes effective October 1, 2021 – UM AROW 1837

March 2021 medical drug benefit clinical criteria updates

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Let’s vaccinate

Help increase your vaccination rates and close gaps-in-care with these tools and strategies

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

March 2021 Medical drug benefit clinical criteria updates

Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross results in improved care management for patients

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Let’s vaccinate

March 2021 Medical drug benefit clinical criteria updates

Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross results in improved care management for patients

Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilators

Let’s Vaccinate

Pharmacy information available on anthem.com/ca

Regular check-ins with your clearinghouse could affect timely filing

Don’t miss this: Timely access regulations and language assistance program

Physicians and clinical care teams: Imaging for lower back pain does not improve outcomes, study finds

Anthem Blue Cross provider directory and provider data updates

Keep your contact information current

Network leasing arrangements

Provider education

Two great learning resources on one secure portal

Digital solution options with Availity

Interactive Care Reviewer’s new copy feature decreases time to submit authorization request

Essential information you need to submit EDI corrected claims

Anthem Blue Cross to enhance claim edits for outpatient facility claims

DEXA bone scan criteria for the Federal Employee Program

Provider education program survey: Your voice counts

MCG care guidelines 25th edition

Prior authorization updates for specialty pharmacy

Keeping up with routine vaccination during COVID-19

Aspire Health for members in need of palliative care

Member grievance and appeals process

Complex case management program

Important information about utilization management

Members’ rights and responsibilities statement

Policy reminder: Inpatient readmissions

Updates to the AIM advanced imaging clinical appropriateness guidelines

Anthem Blue Cross working with Optum to collect medical records for risk adjustment

Medical drug benefit clinical criteria updates

Medical policies and clinical utilization management guidelines update

Reminders for Medicare Advantage group retiree PPO plans and national access plus FAQ

Medical drug benefit clinical criteria updates

Medical policies and clinical utilization management guidelines update

CG care guidelines 25th edition

Register for upcoming CME webinars

Join us in a new CME webinar series as we share practices and success stories to overcoming barriers in achieving clinical quality goals, attaining better patient outcomes and improving Stars ratings.

5 Strategies to Improve Your Quality Measures - June 10^th, 12 p.m. or 3 p.m. ET
7 Ways to Enhance Your Patients’ Experience - June 17^th, 12 p.m. or 3 p.m. ET

Register now!

Register today for the In Pursuit of Racial Equity: Deconstructing Bias forum hosted by Anthem Blue Cross and Motivo on June 9, 2021

Join us to hear from a diverse panel of experienced Motivo and Anthem Blue Cross professionals about racial equity and implicit bias. 

Modification to voluntary Cancer Care Quality Program, enhanced reimbursement to begin July 1, 2021

The Industry Health Network

Appointment Scheduler application

Electronic solutions at your fingertips

2021 Affirmative Statement regarding utilization management decisions

A helpful and complete guide to covered well-child visits

May is National High Blood Pressure education month

A WISEWOMAN™ knows that improving blood pressure is good for the heart.

Resources to support diverse patients and communities

Send larger digital attachments through Availity

Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs

Member grievance process and forms must be made available upon request at provider office

Anthem Blue Cross provider directory and provider data updates

Easily update provider demographics with the online Provider Maintenance form