California
Provider Communications

Controlling High Blood Pressure and Submitting Compliant Readings

AIM Specialty Health will transition to Carelon Medical Benefits Management Inc.

Appropriate 911 emergency care procedures

Have you reviewed your online provider directory information lately?

Enhancing Provider News website and email communications

Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements

2023 FEP benefit information available online

No cost, unlimited LiveHealth Online medical and psychology visits during the California State of Emergency

Keep up with Medi-Cal news - February 2023

• Prior authorization updates for medications billed under the medical benefit (Enjaymo, Kimmtrak, Tezspire, Voxzogo)
• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization updates for medications billed under the medical benefit (Pluvicto, Opdualag, Alymsys, Yusimry)
• Introducing the Provider Learning Hub

Peralta Community College District offers Medicare Advantage option

Anthem Blue Cross expands specialty pharmacy precertification list

Anthem Blue Cross expands specialty pharmacy precertification list

Specialty pharmacy precertification list expansion

New specialty pharmacy medical step therapy requirements

Keep up with Medicare News - February 2023

• Introducing the Provider Learning Hub
• Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Prior authorization requirement changes effective April 1, 2023
• Medical Policies and Clinical Utilization Management Guidelines update
• Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023

Professional system updates for 2023

Outpatient system updates for 2023

Engagement with your patient counts

Remittance advice message enhancements: Providing clear descriptions and actionable next steps

Childhood Immunization Status and Lead Screening in Children for HEDIS

Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List

Monkeypox and smallpox vaccines: Product code on claims

Engagement with your patient counts

Keep up with Medi-Cal news - January 2023

• Population Needs Assessment report
• Remind your patients to update their Medi-Cal Managed Care information

New plan announcement

Engagement with your patient counts

Keep up with Medicare news - January 2023

• Prior authorization requirement changes
• New specialty pharmacy medical step therapy requirements
• Anthem Blue Cross expands specialty pharmacy precertification list

Keep up with Cal MediConnect news - January 2023

• Prior authorization requirement changes
• New specialty pharmacy medical step therapy requirements
• Anthem Blue Cross expands specialty pharmacy precertification list

An overview of our medical necessity review process

Senate Bill 245 addressing abortion, abortion related services, cost sharing and utilization management, including prior authorizations

CAA: Timely updates help keep our provider directories current

Clinical practice and preventive health guidelines available on anthem.com/ca

Members’ rights and responsibilities

Member’s assessment of behavioral healthcare after-hours messaging in 2022

Coordination of care

Case management program

Contract compliance with accessibility standards for Appointment Availability and Emergency Care instructions after hours care

IngenioRx will become CarelonRx on January 1, 2023

Signature requirements for laboratory orders or requisitions

Reminder - updated AIM Musculoskeletal program effective January 1, 2023 - site of care reviews

Reimbursement policy retraction: updates to professional and facility reimbursement policies

Reimbursement policy update: Multiple Surgery - Facility

Reimbursement policy retirement: Acupuncture Billed with Evaluation and Management - Professional

Overlapping Blue Plan service areas

BlueCard program quick tips

Find answers to BlueCard questions

Practice status: open or closed

Does your practice offer telehealth services? Let us know!

Pharmacy information available on the provider website

Update to the Pregnancy Notification Form

New Digital Provider Enrollment tool added to Availity

Keep up with Medi-Cal news - December 2022

• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization updates for medications billed under the medical benefit (Releuko, Vabysmo)

2023 Medicare Advantage service area and benefit updates

Personal home helper benefit ending

Keep up with Medicare news - December 2022

• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Medical Policies and Clinical Utilization Management Guidelines update

Cal MediConnect Plans change effective January 1, 2023

Keep up with Cal MediConnect news - December 2022

• Medical Policies and Clinical Utilization Management Guidelines update
• Medical drug benefit Clinical Criteria updates

Support documentation for AIM prior authorization requests

Regulatory HMO Contract Amendment – HMO Provider Agreement with Anthem Blue Cross

2022 Provider satisfaction survey

CAA: Keep your provider directory information up to date

Claims status message enhancements: Providing clear descriptions and actionable next steps

Authorization application enhancements: Faster, easier, and more efficient

Join our webcast on Wednesday, November 9, 2022, at 11 a.m. ET. Register here.

Submit digital attachments within seven-calendar days for claims filed with a PWK segment indicator

RETRACTION - You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too

Visit the Provider Learning Hub to view our latest learning opportunities

Remote EMR access service for HEDIS

Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

Important information about utilization management

Alcohol use disorders often coexist with psychiatric disorders

Keep up with Medi-Cal news - November 2022

• Prior authorization requirement changes effective November 1, 2022
• Diabetes Prevention Program
• Medical drug benefit Clinical Criteria updates
• No Wrong Door policy

New Plan Announcement

Personalized Match

Keep up with Medicare news - November 2022

• Medical drug benefit Clinical Criteria updates
• Anthem Blue Cross expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements (Avastin, Mvasi)
• New specialty pharmacy medical step therapy requirements (Zarxio)

Keep up with Cal MediConnect news - November 2022

• Anthem Blue Cross expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirement (Avastin, Mvasi)
• New specialty pharmacy medical step therapy requirement (Zarxio)
• Medical drug benefit Clinical Criteria updates

Register for our upcoming CME webinar about low back pain management

Action Required: 2022 Member Grievance and Appeals Attestation Requirement

Help for members impacted by wildfires

Monkeypox and smallpox vaccines: Product code on claims

CAA: Review your online provider directory information

The Provider Learning Hub is here

We want to hear from you – 2022 Provider Satisfaction Survey

National Accounts 2023 pre-certification list

Member benefit lookup by procedure code

IngenioRx will become CarelonRx on January 1, 2023

Pharmacy information available on provider website

Members’ Rights and Responsibilities section

Reimbursement Policy RETRACTION: Sexually transmitted infections testing – professional

Monkeypox resources and recommendations for our care providers

New specialty pharmacy medical step therapy requirements

Keep up with Medi-Cal news – October 2022

• Prior authorization updates for medications billed under the medical benefit for Tivdak, Saphnelo, Ryplazim

Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

Courtesy notification of specialty pharmacy medical step therapy updates

Reimbursement Policy RETRACTION: Sexually transmitted infections testing – professional

Policy 21-001, effective 01/01/2022

Keep up with Medicare news – October 2022

• Medicare Part B Precert Expansion Alymsys
• Medicare Part B Precert Expansion Amvuttra Xipere
• Consultation Codes

Courtesy notification of specialty pharmacy medical step therapy updates

Reimbursement Policy RETRACTION: Sexually transmitted infections testing – professional

Keep up with Cal MediConnect news - October 2022

• Medicare Part B Precert Expansion Alymsys

• Medicare Part B Precert Expansion Amvuttra Xipere

Monkeypox resources and recommendations for our care providers

Continuing to Explore the Intersection of Race and Disability