Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado, has updated our Provider and Facility Manual to become effective December 1, 2022.

 

As of today, the new manual is available online:

  • Go to anthem.com and select Providers.
  • Under the Provider Resources heading, select Policies, Guidelines, and Manuals.
  • Select Colorado if you haven’t done so already.

 

To access the manual effective December 1, 2022:

  • Under the Provider Manual heading, select Download the Manual under the banner.
  • This version is effective beginning December 1, 2022, but available for review as of September 1, 2022. 

 

To access the manual still effective until August 31, 2022:

 

Please note that the manual is available in a PDF version for ease of printing, but we encourage you to view online or only print individual sections to help conserve paper.

 

Changes were made to the following sections:

  • Insurance requirements
  • Credentialing
  • Claims submission
  • Medical records submission (solicited and unsolicited)
  • Electronic data interchange (EDI)
  • Claim payment disputes
  • Clinical appeals
  • Reimbursement requirements and policies
  • Medical Policies and Clinical Utilization Management (UM) Guidelines
  • Utilization management
  • AIM Specialty Health®*
  • Quality Improvement Program
  • Member rights and responsibilities
  • Overview of HEDIS®
  • Centers of Medical Excellence
  • Audit and review
  • Fraud, waste, abuse, and detection

Thank you for your continued participation in our network.

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

* AIM Specialty Health is an independent company providing some utilization management services on behalf of Anthem Blue Cross and Blue Shield.

 

COBCBS-CM-012310-22



Featured In:
December 2022 Anthem Provider News - Colorado