We are asking you to review your online provider directory information on a regular basis to ensure it is correct. Access your information by visiting anthem.com/ca, select Providers, then under Provider Overview, choose Find Care.

Submit updates and corrections to your directory information using our online Provider Maintenance Form. Online update options include:

• add/change an address location
• name change
• tax ID changes
• provider leaving a group or a single location
• phone/fax number changes
• closing a practice location

Once you submit the form, we will send you an email acknowledging receipt of your request.

The Consolidated Appropriations Act (CAA) contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. By reviewing your information regularly, you can help us ensure your online provider directory information is current.

799-0322-PN-CA

News for 2022

• The 2021 Provider Appointment Availability Surveys (PAAS) have recently concluded.
• Each year we communicate Anthem’s Timely Access Regulations and Language Assistance Program to our commercial Medical and Behavioral Health networks via an annual provider mailing.  The 2022 mailing was completed in February.
• SB 221, effective July 1, 2022 – Timely Access Requirements for Non-Physician Mental Health/Substance Use Disorder Appointments.  More details follow the Access Standards for Medical Professionals table below.

Please take a moment to review and share with your staff the Access Standards tables for Medical Professionals and Behavioral Health that follow.

Access Standards for Medical Professionals

Note: The next available appointment date and time can be either In-Person or by Telehealth.

For questions, please visit the Contact Us page on our provider website for up-to-date contact information. You can also email the Provider Experience team directly using the electronic form.

Changes are coming!  Effective July 1, 2022 – Timely Access Requirements for Non-Physician Mental Health/Substance Use Disorder Appointments

On October 8, 2021, the State Senate passed SB 221. This bill requires health care service and Managed Care Plans that fall under the jurisdiction of Department of Managed Health Care and the Department of Insurance, to ensure that appointments with Non-Physician Mental Health and Substance Use Disorder providers are subject to the Timely Access Requirements, as specified on the charts below, beginning July 1, 2022.  This bill also requires that all health plans ensure that enrollees who are undergoing a course of treatment for an ongoing Mental Health or Substance Use Disorder condition can schedule a follow up appointment with their Non-physicians Mental Health Care or Substance use Disorder provider within 10 business days of the prior appointment.

We hope this clarifies Anthem’s expectations and your obligations regarding compliance with the Timely Access Regulations. Our goal is to work with you to successfully meet the expectations for the requirements with the least amount of difficulty and member abrasion.

Access Standards for Behavioral Health and EAP Providers

* The DMHC Timely Access standard is 15 Business days for Psychiatrists; however, to comply with the NCQA accreditation standard of 10 Business Days, Anthem uses the more stringent standard.

Note:  The next available appointment date and time can be either In-Person or by Telehealth services.

For questions, please visit the Contact Us page on our provider website for up-to-date contact information. You can also email the Provider Experience team directly using the electronic form.

Why is this important?  These are California state regulations.

Blue Cross of California dba Anthem Blue Cross and Anthem Blue Cross Life & Health Insurance Company (collectively, Anthem”) are committed to keeping you, our network partners, updated on our activities related to our compliance with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) Timely Access to Non-Emergency Health Care Services Regulations (the “Timely Access Regulations”), respectively.

To ensure compliance with these Timely Access Regulations, three (3) surveys are conducted annually; and the 2021 surveys have recently concluded.  These activities include, but are not limited to the following:

• Provider Appointment Availability Survey
• Provider Satisfaction Survey
• Provider After – Hours Survey

Each year we communicate Anthem’s Timely Access Regulations and Language Assistance Program to our commercial Medical and Behavioral Health networks.  The 2022 notice was mailed in February.  This information also includes access to non-emergency health care services within prescribed timeframes (also referred to as the “time elapsed standards” or “appointment wait times”). We appreciate that in certain circumstances time-elapsed requirements may not be met. The Timely Access Regulations have provided exceptions to the time-elapsed standards to address these situations:

Extending Appointment Wait Time: The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the patient.

Preventive Care Services and Periodic Follow-up Care: Preventive care services and periodic follow up care are not subject to the appointment availability standards. These services may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed health care provider acting within the scope of his or her practice. Periodic follow-up care includes but is not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease.

Advanced Access: The primary care appointment availability standard may be met if the primary care physician office provides “advanced access.” “Advanced access” means offering an appointment to a patient with a primary care physician (or nurse practitioner or physician’s assistant) within the same or next business day from the time an appointment is requested (or a later date if the patient prefers not to accept the appointment offered within the same or next business day). Note: This exception does not apply to commercial Behavioral Health.

24/7 NurseLine Gives Peace of Mind

Anthem members have access to our 24/7 NurseLine. A convenient way to ask questions or get advice from a registered nurse anytime. Locate the toll-free phone number on the back of the Member ID card and the wait time is not to exceed 30 minutes.  

Help is a Phone Call Away

Members and Providers have access to Anthem’s Member Services team for general questions or when having difficulty obtaining a referral to a provider. Call the toll-free phone number listed on the back of the member ID card for assistance. A representative may be reached within 10 minutes during normal business hours.

For Patients (Members) with DMHC Regulated Health Plans

If you or your patients are unable to obtain a timely referral to an appropriate provider or for more information about the regulations, visit the DMHC website at www.dmhc.ca.gov or call toll-free 1-888-466-2219 for assistance.

For Patients (Members) with CDI Regulated Health Plans

If you or your patients are unable to obtain a timely referral to an appropriate provider or for more information about the regulations, visit the CDI website at www.insurance.ca.gov or call toll-free 1-800-927-4357 for assistance.

Language Assistance Program

For members whose primary language is not English, Anthem offers, at no cost, language assistance services through interpreters and other written languages. If you or the member is interested in these services, please call the Anthem Member Services number on the member’s ID card for help (TTY/TDD: 711).

We hope this clarifies Anthem’s expectations and your obligations regarding compliance with the Timely Access Regulations. Our goal is to work with you, to successfully meet the expectations for the requirements with the least amount of difficulty and member abrasion. Anthem can only achieve this compliance with the help of our network providers, you! 

791-0322-PN-CA

Colorectal cancer is the most common cause of cancer death among Asian Americans¹, while African Americans are 40% more likely to die from the disease than any other racial or ethnic group² in the United States. There are many possible reasons for the differences in survival rates among these racial and ethnic groups, but the common thread between them both is screening. For African Americans and Asian Americans, the reluctance could be cultural. They may not be as likely to ask about the screenings as their White counterparts.

Resources to help talk to patients about colorectal cancer screening

The Centers for Disease Control and Prevention website is an excellent resource for information about colorectal cancer that you can share with your patients. There is even a quiz to help your patients understand the importance of screening as a prevention.

We’ve also developed two videos for you to play in your patient waiting room, share with patients in the exam room, or share the link through your digital schedulers.

Colorectal Screening for Asian Americans
Colorectal cancer screening for African Americans

Measure up: HEDIS ® measures members ages 50–75 who receive the appropriate screening for colorectal cancer.

There are multiple test types that meet the requirement:

• Screening colonoscopy every 10 years
• Screening flexible sigmoidoscopy every 5 years
• Computed tomography (CT) colonography every 5 years
• Screening fecal occult blood test (FOBT) annually
• FIT DNA (i.e., Cologuard®) at home testing every 3 years

Coding Tips

For screening, use the appropriate code:

For exclusions, use the appropriate ICD-10 code:

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

1 “Colorectal cancer in the United States and a review of its heterogeneity among Asian American subgroups”, https://onlinelibrary.wiley.com/doi/full/10.1111/ajco.13324#:~:text=Colorectal%20cancer%20is%20the%20second,common%20in%20the%20%20United%20States

2 “Colorectal Cancer Rates Higher in African Americans, Rising in Younger People”, https://www.cancer.org/latest-news/ectal-cancer-rates-higher-in-african-americans-rising-in-younger-people.html
820-0322-PN-CA

Patients say they more likely to have a cancer screening when their physician recommends it. What else can you do to influence cancer screenings?¹

• Understand the power of the physician recommendation.

• Your recommendation is the most influential factor in whether a person decides to get screened.
• Patients are 90% more likely to get a screening when they reported a physician recommendation.
• “My doctor did not recommend it,” is the primary reason for screening avoidance.

• Recognize cultural barriers that may impact your diverse patients

• Culturally sensitive conversations with your patients can help with fear, embarrassment, anxiety, and misconceptions about screenings.
• Go to mydiversepatients.com for information and resources.

• Measure the screening rates in your practice; it may not be as high as you think.

• Set goals to get screening rates up.
• Follow the HEDIS® guidelines included in this article to help accurately track your care gap closures.

• More screening doesn’t have to mean more work for you.

• Reach out to us about available member data – we may be able to help identify or supply access to data for those members who are due screenings.
• Develop a reminder system, which has been demonstrated to be effective, to remind you and staff that patients have screenings due.

• Help members access benefit information about screenings to eliminate the cost barrier.

• Log onto Availity.com and use the Patient Information tab to run an Eligibility and Benefits inquiry.
• Members can access their benefit information by logging onto Anthem.com, through Live Chat, or by downloading the Sydney Health App.
• Blue Cross Blue Shield Service Benefit Plan members, also known as Federal Employee Program® members, can access their benefit information by logging onto fepblue.org, or by downloading the fepblue App from the Apple Store or on Google Play.

Measure Up: Cancer Screening for Women HEDIS® Measure Specifications

Organized and continuous screenings along with removal of precancerous lesions can lead to a 60% decrease in cervical cancer.²

Cervical Cancer Screening (CCS) is measured by the percentage of women 21 to 64 years of age who were screened for cervical cancer using either of the following criteria:

• Women 21–64 years of age who had cervical cytology performed within the last 3 years.
• Women 30–64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
• Women 30–64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

1 http://thecanceryoucanprevent.org/wp-content/uploads/14893-80_2018-PROVIDER-PHYS-4-PAGER-11-10.pdf

2 National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/9253676/

819-0322-PN-CA

In the months ahead, you will notice that our correspondence to you has changed. We’ve simplified our requests for additional information by providing exactly the information you need to know, enabling quicker claims processing and faster payments.

Enabling digital responses
Our new correspondence format includes the easiest, fastest, and most efficient way to return the information requested. We’ll provide you with instructions about how to submit the information digitally. Whether it is through the Claims & Payments application for resubmission or by using the Attachments application, it is all in one place and accessible by logging onto Availity.com.

Digital responses to our request for additional information is one of the ways we can work together to reduce the amount of time and expense associated with claims processing.

Become an Availity user today

As a reminder, effective January 1, 2022, the Coastal Foundation located in Salinas, California, which provided claims and customer service for Self-Insured Schools of California (SISC) members no longer support those members. Please be sure to verify each member’s ID card to obtain the most up to date customer service phone number and mailing address. Up to date information can also be found in the Availity portal. SISC members can be identified by alpha prefix “SIF” on their member ID card.

Consumer surveys show that doctors are the most persuasive and influential source of information around vaccines. Anthem Blue Cross (Anthem) is working to make it easier for physicians to offer their strong recommendations for vaccinations – especially vaccines for COVID-19 and influenza.

Anthem recently launched a single page to host resources for health care professionals related to vaccination, including a guide to talking with reluctant patients to respond to common concerns, and one comparing flu and COVID-19 vaccines.

We will continue to refresh and add to available content on the new vaccination resource page.  

Visit our website for the most up to date COVID-19 information from Anthem.

776-0322-PN-CA 

Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) is an annual standardized survey conducted between February and May to assess consumers’ experience with their providers and health plan. A random sample of your adult or child patients may receive the survey.

More than half of the questions used for scoring are directly impacted by providers. These questions are:

• When you needed care right way, how often did you get care as soon as you needed?
• How often did you get an appointment for a check-up or routine care as soon as you needed?
• How often was it easy to get the care, tests, or treatment you needed?
• How often did you get an appointment to see a specialist as soon as you needed?
• How often did your personal doctor seem informed and up-to-date about the care you got from other doctors or other health providers?
• How would you rate your personal doctor?
• How would you rate the specialist you see most often?
• How would you rate all your healthcare in the last six months?

Interested in how you can improve CAHPS performance?

Anthem Blue Cross offers an online course for providers and office staff designed to learn how to improve communication skills, build patient trust and commitment, and expand your knowledge of the CAHPS survey. The Improving the Patient Experience course is available at no cost and is eligible for one continuing medical education (CME) credit by the American Academy of Family Physicians. It can be accessed at: https://www.mydiversepatients.com/le-ptexp.html.

ACA-NU-0403-21

Please continue to check for important Cal MediConnect updates at https://providers.anthem.com/california-provider/communications/news-and-announcements for the latest Cal MediConnect information, including:

• Medical step therapy updates

• Medical step therapy updates
• Phone number change for AIM in California

In April 2022, Anthem Blue Cross (Anthem) will replace its current internal provider demographic management system with a new Strategic Provider System (SPS). This investment in advanced technology will significantly improve provider data accuracy and transparency, enhancing the overall provider experience. New system features will strengthen our ability to match submitted claims for more accurate pricing and processing.

System upgrades special notice

During the first phase of our improvements, Anthem will implement system upgrades April 1, 2022, through April 8, 2022. Provider updates submitted during this period will be processed after April 8, 2022. We appreciate your patience as we upgrade our systems.

Next steps: new Provider Data Management coming soon

Beginning in June 2022, the second phase of our improvement initiative will be integration with Availity’s* Provider Data Management (PDM) functionality, which will roll out in phases. This single, easy-to-use portal, will allow providers to view, maintain, update, and attest to the accuracy of provider demographic information for Anthem. The Availity portal will enable providers to complete required verifications online via a simplified quick verification procedure – eliminating the need to fax, email, or use separate online forms. This service will replace the way you currently send Anthem your demographic updates.

Get ready for the change today

If your organization is not already registered on the Availity Portal, we strongly encourage you to get started right away. Your organization’s designated administrator can go to https://www.availity.com to register and find other helpful information about using Availity. Availity is Anthem’s secure provider portal platform where providers can enjoy the convenience of digital transactions, including prior authorization submissions, claims submission and benefit and eligibility look-up.

For questions about Availity, call 800-AVAILITY (800-282-4548).

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross.
ABCCRNU-0223-22 and ABCCARE-0631-21

On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following codes:

• K1022 — Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type

Not all PA requirements are listed here. PA requirements are available to contracted providers on the provider website at https://www.anthem.com/ca/medicareprovider > Login or by accessing Availity.* Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the member’s ID card.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross.

ABCCRNU-0222-22

Effective January 1, 2022, Teamsters Retiree Trust will offer a Medicare Preferred PPO plan with Anthem Blue Cross. Retirees with Medicare Parts A and B are eligible to enroll in the Local Preferred Provider Organization (LPPO) product.

Benefits

The plan includes the National Access Plus benefit, which allows retirees to receive services from any provider, as long as the provider is eligible to receive payments from Medicare. The Medicare Advantage plan offers the same hospital and medical benefits that original Medicare covers, while covering additional benefits that original Medicare does not, such as LiveHealth Online* (telehealth) and SilverSneakers^®.*

Teamsters Retiree Trust members’ copay or coinsurance percentage will be the same whether their provider is in- or out-of-network. Locally or nationwide, doctors or hospitals, member share-of-cost (SOC) doesn’t change.

The prefix on Teamsters Retiree Trust member ID cards will be MBL. The cards will also show the Teamsters Retiree Trust name and MA and PPO icons.

Claims

Providers will follow their normal claim filing procedures for Teamsters Retiree Trust member claims. Claims should not be filed with original Medicare. Contracted and noncontracted providers may call Provider Services at 833-848-8730, the number on the back of the member’s ID card, for eligibility, prior authorization requirements, and any questions about the Teamsters Retiree Trust member benefits or coverage.

Detailed prior authorization requirements also are available to contracted providers by accessing the Provider Self-Service Tool at https://www.availity.com.*

* LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Anthem Blue Cross. Tivity Health, Inc. is an independent company providing the SilverSneakers fitness program on behalf of Anthem Blue Cross. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross.

ABCCRNU-0220-21

Summary: On September 22, 2021, and November 19, 2021, the Pharmacy and Therapeutics (P&T) committee approved the following Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross. These policies were developed, revised, or reviewed to support clinical coding edits.

Visit Clinical Criteria to search for specific policies. If you have questions or need additional information, use this email.

See the explanation/definition for each category of Clinical Criteria below:

• New: newly published criteria
• Revised: addition or removal of medical necessity requirements, new document number
• Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive

Share this notice with other members of your practice and office staff.

Please note: The Clinical Criteria listed below applies only to the medical drug benefits contained within the member’s medical policy. This does not apply to pharmacy services.

ABCCRNU-0219-22

Medication adherence improves overall member health and reduces hospitalizations. According to the World Health Organization, “Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.”¹

Did you know?

• Most medication-related ER visits and hospitalizations in the U.S. (up to 70%) are caused by

nonadherence to medication.²

• Studies show that 50 to 60% of patients are not taking their prescribed medications correctly or at all.³
• Improved adherence can drive positive health and economic outcomes.

• Patients’ adherence to statin medications at 12 months had improved LDL, reduced hospitalizations, and lower healthcare costs.⁴

Best practices for improving adherence

Support the implementation of medication nonadherence prevention strategies at each step of the medication use process:

• Prescribe maintenance medications for diabetes, cholesterol, and hypertension from the

Anthem Blue Cross (Anthem) Medicare Advantage $0 copay list.

• Encourage IngenioRx* Home Delivery to improve medication adherence, prevent refill gaps, avoid long waits at the pharmacy, and to reduce costs.
• IngenioRx Home Delivery members have 2 to 3% higher adherence rates
• E-prescribe, fax 800-378-0323, or phone-in prescriptions 833-203-1742

• Enrolled nonadherent patients may benefit from a multi-dose packaging of medications.

CVS pharmacy^® SimpleDose™ and PillPack are preferred pharmacies that offer multi-dose packaging with free home delivery. To enroll, go to:

• CVS.com/multidose or call 800-753-0596. Members may also enroll at their local CVS pharmacy. Members residing in the District of Columbia, Georgia, or South Carolina should call 844-650-1637.
• Pillpack.com/blue or call 866-282-9462.

• Offer members the opportunity to use ZipDrug, which offers free access to high performing pharmacies that provide customized medication services, hand-delivered prescriptions, and increase medication adherence rates. Go to anthem.com/zipdrug or call 844-947-3748.
• Patients who take medications for diabetes, cholesterol, and hypertension and enrolled in ZipDrug had a 4 to 10% increase in medication adherence rates.

• Encourage digital solutions: Sydney app can help Anthem members manage their medications through:
  • Enrollment in ZipDrug
  • Home delivery set-up
  • Manage auto-refill and renew
  • Text message reminders on prescriptions

Want more information regarding all the recommended best practices?

Best practices for medication adherence are reviewed in this brief video.

Resources:

1 World Health Organization. Adherence to long-term therapies: evidence for action. Geneva:

   World Health Organization; 2003. http://apps.who.int/medicinedocs/pdf/s4883e/s4883e.pdf.

   Accessed Dec.22, 2021.

2 Cutler, Rachelle Louise et al. “Economic impact of medication non-adherence by disease groups: systematic

   review.” BMJ open vol. 8,1 e016982. 21 Jan. 2018, doi:10.1136/bmjopen-2017-016982

3 Journal of Managed Care & Specialty Pharmacy 2020 26:12, 1529-1537

4 JAMA.2018;320(23):2461-2473. https://pubmed.ncbi.nlm.nih.gov/30561486/
ABCCRNU-0035-22

Annual wellness visits (AWVs) are an important yet underutilized vehicle for ensuring successful value-based payment (VBP) arrangements. In 2022, there is an opportunity to increase your AWVs and, by extension, the health of your patients and your success in VBPs. 

Per the American Academy of Family Practitioners (AAFP), “90 percent of patients who had received an AWV said they did so at the recommendation of their physician.” AWVs are a yearly exam (usually with a physician) to develop or update a personalized prevention plan and assess health status and any social, psychological, and behavioral health risks. An AWV can be a useful tool for improving quality of care, providing proactive care management, facilitating care coordination, and positively impacting up to 20 Medicare Advantage Star measure ratings for health plans.

There is often confusion between an AWV and an annual routine physical (ARP). The ARP is more comprehensive than an AWV. It consists of a physical exam by a physician and includes bloodwork, screenings, and other tests. The AWV involves checking standard measurements such as blood pressure, height, and weight. AWVs are free for Medicare Advantage members and, in many instances, can be conducted remotely via telehealth.

Note: CMS does allow both visit types to occur on the same date/time and providers can submit one claim encompassing each type.

There are many provider benefits for completing an AWV, including:

• Opportunity to develop a complete medical history for members
• Strengthened relationship with member
• Ability to provide proactive care to member
• Increased performance on quality metrics
• An ongoing, sustainable revenue stream for practice
• Vehicle for providers to obtain caregiver demographics

There are also many member benefits for completing an AWV, including:

• No copay
• Strengthened relationship with healthcare providers

• Annual comprehensive preventive evaluation
• Reduced risk of chronic conditions
• Keeps members out of the hospital
• Prevents accidents at home

In the ever-increasing emphasis on value-based care that focuses on shared savings, it is urgent for providers to complete an AWV for each of their assigned members. Doing so keeps members healthy, reduces healthcare costs, and can increase practice revenues.

ABCCARE-0724-22

Please continue to check for important Medi-Cal Managed Care updates at https://providers.anthem.com/california-provider/communications/news-and-announcements for the latest Medi-Cal Managed Care information, including:

• Prior authorization requirement changes — 97535 Self-care/home management training

To support the health of our members, Anthem Blue Cross (Anthem) is sending urinary tract infection (UTI) toolkits to select members who were seen in the ER for a UTI.

This useful kit contains:

• A water bottle to help your patient stay
• UTI test strips with instructions on use if having These are test strips that are also available over the counter.
• Basic instructions on how to use the toolkit and reasons to seek

Anthem members may reach out to you when they receive their toolkit.  If you have any questions, please contact one of our Medi-Cal Customer Care Centers at:

• 800-407-4627 (outside A. County)
• 888-285-7801 (inside A. County)

ACA-NU-0414-22 and ACA-NU-0381-21

The Clinical Utilization Management (UM) Guidelines and Third-Party Criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed.

Please share this notice with other members of your practice and office staff. To view a guideline,  visit https://www.anthe m.com/ca/provide r/policie s/clinical-guide line s/search.

Updates:

Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive.

• *CG-LAB-14 — Respiratory Viral Pane l Testing in the Outpatie nt Se tting
  • Clarified that respiratory viral panel (RVP) testing in the outpatient setting is medically necessary when using limited panels involving five targets or less when criteria are met
  • Added RVP testing in the outpatient setting using large panels involving six or more targets as not medically necessary
  • Added RVP testing in the outpatient setting using large panels involving six or more targets as not medically necessary

ACA-NU-0410-22 and ACA-NU-0393-21