California
Provider Communications

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

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

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

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

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

Alcohol use disorders linked to chronic diseases

Reimbursement policy update – Modifiers 25 and 57: Evaluation and Management with Global Procedures

Complex Case Management program

Enhancing claims attachment processes through digital applications

Prior authorization updates for medications billed under the medical benefit

New specialty pharmacy medical step therapy requirements

Keep up with Medi-Cal news – September 2022

• Clinical criteria update

• Access to care standards

Reimbursement policy update – Modifiers 25 and 57: Evaluation and Management with Global Procedures

Reminder: AIM Prior authorization phone number change for Medicare

Enhancing claims attachment processes through digital applications

Anthem Blue Cross Expands Specialty Pharmacy Precertification list

Keep up with Medicare news – September 2022

• Clinical Criteria Updates

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

• Anthem Blue Cross expands specialty pharmacy precertification list

Prior authorization requirement changes effective date December 1, 2022

Reimbursement policy update – Modifiers 25 and 57: Evaluation and Management with Global Procedures

Anthem Blue Cross Expands Specialty Pharmacy Precertification list

Keep up with Cal MediConnect news - September 2022

• Anthem Blue Cross expands specialty pharmacy precertification list

• Clinical Criteria Updates

HEDIS 2022: Summary of changes from NCQA

Chlamydia screening

Using SBIRT to address opioid and substance use disorders

Updated quality performance requirements

The cost of alcohol use disorder

Prior authorization requirement changes updated effective date November 1, 2022

Prior authorization requirement changes effective August 1, 2022

MCG care guidelines 26th edition

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medi-Cal news – July 2022

• What is an e-Consult?
• Prior authorization updates for medications billed under the medical benefit

Update use of Modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services

MCG care guidelines 26th edition

Cancer Care Navigator

Keep up with Medicare news – July 2022

• New specialty pharmacy medical step therapy requirements

MCG care guidelines 26th edition

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Cal MediConnect news - July 2022

• New specialty pharmacy medical step therapy requirements
• New specialty pharmacy medical step therapy requirements

Medical drug benefit Clinical Criteria updates

Network adequacy – subcontractor expectations

Keep up with Medi-Cal news – June 2022

• Prior authorization updates for medications billed under the medical benefit
• Provider notification process
• Provider coding education: Webinars and on-demand trainings are now available!

Updates to AIM Specialty Health Advanced Imaging clinical appropriateness guidelines

Authorizations for post-acute care services for PPO Medicare Advantage individual, Group Retiree Solutions (GRS), and Dual-Eligible Plan members

Medical drug benefit Clinical Criteria updates

Medical policies and clinical utilization Management guidelines update

Provider notice for COVID-19 testing

Keep up with Medicare news – June 2022

• Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines
• Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines
• New specialty pharmacy medical step therapy requirements
• Anthem Blue Cross expands specialty pharmacy precertification list

Keep up with Cal MediConnect news - June 2022

• New specialty pharmacy medical step therapy requirements
• Medical drug benefit Clinical Criteria updates
• Anthem Blue Cross expands specialty pharmacy precertification list

Expedited grievances

Screening for alcohol use disorder in high-prevalence demographics

Keep up with Medi-Cal news – May 2022

• Prior authorization requirement change for HCPCS code K1022
• Provider notification process
• New specialty pharmacy medical step therapy requirements

Convenient, reliable at-home testing for colorectal cancer and diabetes care

New Strategic Provider System implementation May 2022

HEDIS 2022: Summary of changes from NCQA

New specialty pharmacy medical step therapy requirements

Southern California Drug Benefit Fund moves to the Anthem Blue Cross Medicare Advantage plan

Keep up with Medicare news – May 2022

• Anthem Blue Cross expands specialty pharmacy precertification list
• Anthem Blue Cross expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements

New specialty pharmacy medical step therapy requirements

Keep up with Cal MediConnect news - May 2022

• Anthem Blue Cross expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements
• Anthem Blue Cross expands specialty pharmacy precertification list

Save time by using CPT II codes: Introducing FEP Quality Reimbursement Program for PPO Providers

The Anthem, Inc. name is changing

Reimbursement policy update: Inpatient Readmissions