California
Provider Communications

New specialty pharmacy medical step therapy requirements

Get your payments faster when you sign up for electronic funds transfer

Medical drug benefit clinical criteria updates

Keep up with Cal MediConnect news October 2021

• May 2021 Medical Policies and Utilization Management Guidelines update

• 2021 affirmative statement concerning utilization management decisions

Medical policies and clinical utilization management guidelines update

MCG care guidelines: 24th Edition

Helping our members

CG care guidelines 25th edition

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

Modifier use reminders

Updates to AIM Sleep Disorder Management clinical appropriateness guideline

Electronic submission is preferred method for requesting pharmacy prior authorization

Medical drug clinical criteria updates – Quarter 2

Reminder: Mid-level practitioners are required to file using their NPI

MMP clinical criteria updates

Medical drug clinical criteria updates – Quarter 1

MMP reimbursement new policy: Update drug screen testing

Important update on Botox® for Medicare members of Anthem Blue Cross

Prior authorization requirements: new 2020 codes for coverage and precertification

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Anthem Blue Cross expands specialty pharmacy precertification list

Medical records request for risk adjustment

Medical drug benefit clinical criteria updates for November 2019

Keep up with Cal MediConnect news - January 2022

• Medical step therapy updates

Update: Evaluation and management with Modifier 25

MMP Prior authorization requirements for DME repair and portable oxygen concentrator

Medical drug benefit clinical criteria updates for December 2019

Medical policies and clinical utilization management guidelines update

Transition to AIM Specialty Health rehabilitative services clinical appropriateness guidelines

Medical drug benefit Clinical Criteria updates – August 2020

Medical drug benefit Clinical Criteria updates

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

Medical drug benefit Clinical Criteria updates

Prior authorization requirements for Azedra (iobenguane l 131) and Poteligeo (mogamulizumab)

Electronic data interchange migration to Availity

Reimbursement policy update; Medical recalls, policy 06-111 – effective November 1, 2018

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

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

MCG Care guidelines update and customizations

June 2019 medical policies and clinical utilization management guidelines update

Coming soon: electronic attachments

Medical drug benefit Clinical Criteria updates

Reimbursement Policy update: Nurse practitioner and physician assistant services, professional

Reimbursement Policy (effective 04/24/20)

New specialty pharmacy medical step therapy requirements

Digital transactions cut administrative tasks in half

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

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

Prior authorization requirements for Part B drugs: Retacrit (epoetin alfa-epbx), Damoctocog and llumya (tildrakizumab)

Short and long acting narcotics regulatory changes and limits to days’ supplies

Prior authorization requirments for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila (pegfilgrastim-jmbd)

Prior authorization form notification

Claims requiring additional documentation

Keep up with Cal MediConnect news - September 2021

Short and long acting narcotics regulatory changes and limits to days’ supplies

Prior authorization requirements for Part B drug Nivestym

Electronic data interchange gateway update

MediConnect Plan network update

Professional and Facility Reimbursement Policy Update: Multiple and Bilateral Surgery

Reimbursement Policy Update: Split-Care Surgical Modifiers, effective May 1, 2020

Reimbursement policy update, Modifier 62: Co-Surgeons

Pharmacy benefit manager change to IngenioRx

Cal MediConnect Plans change effective January 1, 2023

Changes to prior authorization requirements

Keep up with Cal MediConnect news - December 2022

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

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

Transition to AIM Specialty Health Rehabilitative Services Clinical Appropriateness Guidelines

Transition to AIM Small Joint guidelines

Claims editing update for ICD-10-CME Excludes 1 notes

MCG care guidelines 26th edition

Clinical criteria updates

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Cal MediConnect news November 2021

• Anthem Blue Cross expands specialty pharmacy precertification list

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

Submit behavioral health authorizations via our online Interactive Care Reviewer tool

New MCG Care Guidelines 24th edition

Updates to AIM musculoskeletal program clinical appropriateness guidelines

CORRECTION: Transition to AIM Small Joint guidelines is effective February 4, 2021

August 2020 MMP Medical Policies and Utilization Management Guidelines update

New service types added to Availity

Prepayment clinical validation review process

Unspecified diagnosis code update

New reimbursement policy: drug screen testing

Policy update: Drug screen testing

Policy update: Drug screen testing, effective March 1, 2022

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

Keep up with Cal MediConnect news - December 2021

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

Reimbursement policy update: Inpatient Readmissions

Policy G-13001, effective 07/01/22

Clinical criteria updates

MCG Care Guidelines 24th edition customization

Keep up with Cal MediConnect news - April 2022

• Medical Policies and Clinical Utilization Management Guidelines update
• Quick tips to filing a complete and correct professional claim
• Anthem Blue Cross expands specialty pharmacy precertification list
• Medical drug benefit Clinical Criteria updates

Medical policies and clinical utilization management guidelines update

The Anthem, Inc. name is changing