Colorado
Provider Communications

December 2018 Anthem Provider Newsletter - CO

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Title Category

2019 Medicare Advantage individual benefits and formularies

Medicare

Anthem accepts electronic prior authorization requests for prescription medications online

Products & Programs

Anthem works to simplify payment recovery process for National Accounts membership

Administrative

Availity to serve as EDI entry point for electronic submissions

Administrative

BlueAdvantage HMO on the Pathway HMO Network for Federal Employees

Federal Employee Plan (FEP)

Case Management Program

Products & Programs

Clear Claim Connection

Reimbursement Policies

Clinical Practice and Preventive Health Guidelines available on the web

Products & Programs

CMS Medicare Preclusion List effective April 1, 2019

Medicare

Colorado Public Employees' Retirement Association (PERA) Offers Medicare Advantage Option

Medicare

ConditionCare Program Benefits Patients and Physicians

Products & Programs

Coordination of Benefits for an FEP® member

Federal Employee Plan (FEP)

Coordination of Care

Products & Programs

Health Care Reform Updates (including Health Insurance Marketplace / Affordable Care Act)

Administrative

HEDIS® 2018 Commercial Results Are In

Administrative

Important Information about Utilization Management

Products & Programs

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Integrated Care Model for plans purchased on the Health Insurance Marketplace / Connect for Health Colorado benefits patients and physicians

Products & Programs

Introducing the new Clinical Criteria page for injectable, infused or implanted drugs

Pharmacy

Keep up with Medicare news

Medicare

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

Members’ Rights and Responsibilities

Products & Programs

Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period - Professional

Reimbursement Policies

Networks at a Glance

Administrative

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

Non-participating lab referrals

Administrative

Pharmacy information available on anthem.com

Products & Programs

Pharmacy information available on anthem.com

Pharmacy

Plans offered in 2019

Administrative

Reimbursement for Convenience Surgical Supply Kits - Professional

Reimbursement Policies

Reimbursement Policies are available online

Reimbursement Policies

Request a Clinical Appeal through new functionality in our Interactive Care Reviewer (ICR) tool on Availity

Administrative

Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Scope of License - Reimbursement Policy Update (Professional)

Reimbursement Policies

System updates for reimbursement policies in 2019 - Professional

Reimbursement Policies

Update to AIM Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Updated Escalation Contact List

Administrative

Updated Prefix Reference List

Administrative

Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

Medical Policy & Clinical Guidelines

Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web

Products & Programs

When and how to initiate Medicare Advantage reopenings

Medicare

“Rule of Eight” Reporting Guidelines for Physical Medicine and Rehabilitation Services - Professional

Reimbursement Policies
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