Colorado
Provider Communications

August 2021 Anthem Provider News and Important Updates - Colorado

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Title Category

Telehealth visits can impact after-hospitalization follow-up care for mental illness

Reductions in missed appointments are significant.

Administrative

Clearing up-coding confusion for retinal eye exams (DRE)

New language for two-year compliance (3072F).

Administrative

Register now for our August CME webinars!

Administrative

Working with Anthem webinars – August 2021 schedule: Quick tips for adding, changing, terming a provider using the Provider Maintenance Form

Administrative

Schedule appointments online through Availity

Digital Tools

Submitting prior authorizations is getting easier

Anthem is transitioning to Availity Authorization.
Digital Tools

New Clinical Guideline: Home Parenteral Nutrition, effective November 1, 2021 (MAC)

Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Reimbursement policy update: Claims requiring additional documentation (facility)

Reimbursement Policies

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS and XU (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Reimbursement policy update: Virtual Visits – Professional and Facility (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Transition to AIM Specialty Health Imaging of the Heart Clinical Appropriateness Guideline for Computed Tomography to Detect Coronary Artery Calcification (MAC)

Material Adverse Change (MAC)
Products & Programs

Updates to AIM Musculoskeletal Program Effective November 1, 2021 – Site of Care Reviews (MAC)

Material Adverse Change (MAC)
Products & Programs

Specialty dose rounding program for certain oncology medications

Pharmacy

Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021

Pharmacy

Anthem Blue Cross and Blue Shield to update formulary lists for commercial health plan pharmacy benefit

Pharmacy

Immune globulin adjusted body weight dosting program beginning August 1, 2021

Pharmacy

Pharmacy information available on anthem.com

Pharmacy

Anthem prior authorization updates for specialty pharmacy are available (MAC)

Material Adverse Change (MAC)
Pharmacy

Some physician requests to AIM require the submission of documentation to support attestations for prior authorization

Products & Programs

Important Update: Change in Email Submission of Service Requests for Federal Employee Program® (MAC)

Material Adverse Change (MAC)
Federal Employee Plan (FEP)

Preventing claims denials: Shingles vaccine

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

Medicare

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

Medicare

Infliximab Step Therapy – effective July 15, 2021

Medicare
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