Change notification to Provider and Facility Manual, effective February 1, 2024

Anthem Blue Cross and Blue Shield (Anthem) and our subsidiary company, HMO Colorado, have updated our Provider and Facility Manual to become effective February 1, 2024.

The new manual is available online:

• Go to anthem.com and select For Providers.
• Under the Provider Resources heading, select Policies, Guidelines, and Manuals.
• Select Colorado if you haven’t already done so.
• Under the Provider Manual heading, select, download the manual under the banner.
• View the manual in the green preview box. This version is effective beginning February 1, 2024, but available for review as of December 1, 2023.

To access the current manual and previous manuals:

• Select the link titled access previous versions and other manuals.
• See the appropriate historical version using the effective dates listed with each manual.

Changes were made to the following sections:

• Insurance requirements
• Clinical data sharing
• Dispute resolution, medication and arbitration
• Availity Essentials
• 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
• Carelon Medical Benefits Management*
• 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.