California
Provider Communications

Annual planned visits

Controlling High Blood Pressure and Submitting Compliant Readings

Western Teamsters Welfare Trust offers Medicare Advantage option

Informational Update Modifier Usage

Shared savings and transition care management after inpatient discharges

Keep up with Medicare News - March 2023

• Carelon Medical Benefits Management, Inc. Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT code list update
• Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines
• Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Clinical Criteria updates
• Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List
• New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)

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

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

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

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)

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

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

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

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

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

The Anthem, Inc. name is changing

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

Reimbursement policy update: Inpatient Readmissions

Policy G-13001, effective 07/01/22

Model of Care required training

The impact of listening

Clinical criteria updates

Keep up with Medicare news – April 2022

• Quick tips to filing a complete and correct professional claim
• Medical Policies and Clinical Utilization Management Guidelines update
• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates
• Anthem Blue Cross expands specialty pharmacy precertification list

Annual wellness visits for Medicare Advantage members

Pharmacy updates

Clinical criteria updates

Teamsters Retiree Trust offers Medicare Advantage option

Provider notification for utilization management authorization rule operations workgroup item 2662

New Strategic Provider System will launch in April 2022

Keep up with Medicare news – March 2022

• Medical step therapy updates

• Phone number change for AIM in California

Get faster payments with EFT

Keep up with Medicare news – February 2022

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

Los Angeles City Employees’ Retirement System adds the medical and prescription drug plan

Northern California Cement Masons, California moves to Medicare Advantage plan

Professional claims – billing referring provider and NPI for home infusion therapy and ambulatory infusion suite

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

Keep up with Medicare news – January 2022

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update
• Medical step therapy updates
• Anthem Blue Cross expands specialty pharmacy precertification list

Policy update: Drug screen testing

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

Updates to AIM Specialty Health Advanced imaging clinical appropriateness guidelines

2022 Medicare Advantage services area and benefit updates

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

Submitting prior authorizations is getting easier

Keep up with Medicare news – December 2021

• Updates to AIM Specialty Health musculoskeletal interventional pain management clinical appropriateness guideline
• Medical drug benefit Clinical Criteria updates
• Protocol for providers serving members with hearing aid coverage administered by Hearing Care Solutions
• New York City Medicare Advantage announcement
• Medical Policies and Clinical Utilization Management Guidelines update
• Medical Policies and Clinical Utilization Management Guidelines update

New York City Medicare Advantage announcement

Updates to AIM Specialty Health cardiology clinical appropriateness guidelines

Clinical criteria updates

Anthem Blue Cross offering Advance Medical Directives program for 2022

Anthem Blue Cross Medicare Advantage FFS HMO network guidance

Electronic data interchange process

Keep up with Medicare news – November 2021

• Anthem Blue Cross expands specialty pharmacy precertification list

New Medicare Advantage plan will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing Providers Nationally

Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees across the United States will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan and have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing. Read important information about this change in the New York City Medicare Advantage announcement.

Information about 2021 special needs plans

New policy: Sexually transmitted infections testing, effective January 2022 - professional

HEDIS® medical record submission made easier with our remote EMR access service

New medical step therapy requirements

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

Keep up with Medicare news – October 2021

• May 2021 Medical Policies and Utilization Management Guidelines update

• 2021 affirmative statement concerning utilization management decisions

Reimbursement policy update: DRG inpatient facility transfers

Utilization management authorization rule operations

Prior authorization form notification

Keep up with Medicare news - September 2021

Preventing claims denials: Shingles vaccine

Know best: Shingles vaccinations are a Medicare Part D benefit whether administered in your office or in the pharmacy.

Prior authorization requirement changes effective October 1, 2021 – UM AROW 1907

Infliximab Step Therapy – effective July 15, 2021

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Let’s vaccinate

Help increase your vaccination rates and close gaps-in-care with these tools and strategies

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

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