California
Provider Communications

December 2018 Anthem Blue Cross Provider Newsletter - California

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Title	Category
Workers’ Compensation Physicians Acknowledgments required by California Code of Regulations §9767.5.1 Medical Provider Networks	Administrative
When and how to initiate Medicare Advantage reopenings	Medicare
Vaginal birth after cesarean certified shared decision making aid available on the web	Policy Updates
Updated prior authorization form for providers	Medi-Cal Managed Care
Update to AIM clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Timely access regulations and language assistance program	Products & Programs
Sign-up now for our Network eUPDATE today – it’s free!	Administrative
Short and long acting narcotics regulatory changes and limits to days’ supplies	Cal MediConnect
Restructure of AIM advanced imaging clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Quarterly pharmacy formulary change	Medi-Cal Managed Care
Provider Education seminars, webinars, workshops and more!	Administrative
Prior authorization requirements for subcutaneous implantable defibrillator system	Medi-Cal Managed Care
Prior authorization requirements for Part B drug Nivestym	Cal MediConnect
Practitioners’ rights during credentialing process	Medi-Cal Managed Care
Pharmacy information available on anthem.com/ca	Pharmacy
New Medicare Advantage provider service phone number beginning January 1, 2019	Medicare
Network leasing arrangements	Administrative
Need up to date pharmacy information?	Medi-Cal Managed Care
Misrouted protected health information	Administrative
Members’ rights and responsibilities	Policy Updates
MediConnect Plan network update	Cal MediConnect
Medicare Part B drugs may include Step Therapy beginning January 1, 2019	Medicare
Los Angeles Unified School District offers Medicare Advantage option	Medicare
Keep up with Medicare news	Medicare
Introducing the new Clinical Criteria page for injectable, infused or implanted drugs	Pharmacy
Interactive Care Reviewer	Administrative
Integrated Care Model for plans purchased on the health insurance marketplace benefits patients and physicians	Administrative
Individual on and off exchange plans: 2019 benefit year update	Administrative
Individual Medicare plans move compound drugs off formulary beginning January 1, 2019	Medicare
Important reminder: Professional reimbursement policy update Scope of License	Reimbursement Policies
Hospital recognition: NTSV C-Section Rates	Administrative
HEDIS 2018: Commercial results are in	Policy Updates
Electronic data interchange gateway update	Medi-Cal Managed Care
Electronic data interchange gateway update	Cal MediConnect
Easily update provider demographics with the online Provider Maintenance Form	Administrative
Coordination of care	Products & Programs
Coordination of benefits for an Federal Employee Plan member	Federal Employee Plan (FEP)
Contracted provider claim escalation process	Administrative
ConditionCare program benefits patients and physicians	Products & Programs
Coding tip: Claims processed with Modifier 79 should be reported by the same health care professional	Administrative
Coding spotlight: Substance use disorders and smoking	Medi-Cal Managed Care
CMS Medicare Preclusion list effective April 1, 2019	Medicare
Clinical practice and preventive health guidelines available online	Policy Updates
Claims system updates for 2019: Professional	Administrative
Claims requiring additional documentation	Medi-Cal Managed Care
Claims requiring additional documentation	Cal MediConnect
Case management program	Products & Programs
Benefit change for Infliximab for Federal Employee Program	Federal Employee Plan (FEP)
Availity to serve as EDI entry point for electronic submissions	Administrative
Anthem works to help ensure appropriate billing of E&M services	Reimbursement Policies
Anthem Blue Cross works to simplify payment recovery process for National Accounts membership	Administrative
Anthem Blue Cross provider directory and provider data updates	Administrative
Anthem Blue Cross accepts electronic prior authorization requests for prescription medications online	Pharmacy
An overview of our medical necessity review process	Policy Updates
2019 Medicare Advantage individual benefits and formularies	Medicare
2019 FEP Benefit information available online	Federal Employee Plan (FEP)

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