Change notification to Provider and Facility Manual, effective December 1, 2022

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

 

As of today, the new manual is available online:

• Go to https://anthem.com and select Providers.
• Under the Provider Resources heading, select Policies, Guidelines, and Manuals.
• Select Colorado if you have not already done so.

 

To access the manual effective November 1, 2022:

• Under the Provider Manual heading, select, download the manual under the banner.
• This version is effective beginning November 1, 2022, but available for review as of August 1, 2022.

 

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

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

 

Please note that the manual is available in a PDF version for ease of printing, but we encourage you to view it 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).
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