Colorado
Provider Communications

July 2021 Anthem Provider News and Important Updates - Colorado

Title	Category
Drug fee schedule update	Administrative
Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual Material Adverse Change (MAC)	Administrative
Clinical quality in practice: CME webinar series	Administrative
Proper coding for in-home monitoring can make a measurable difference for INR	Administrative
Company to retire Blue Precision program at the end of the year	Administrative
Timely receipt of the primary payer’s EOB can help reduce timely filing denials for secondary claims	Administrative
Another mark of the pandemic: An increase in childhood obesity More potato chips, sugary drinks and less physical activity are key contributors	Administrative
Working with Anthem webinars – July 2021 schedule: Anthem networks overview	Administrative
Interactive Care Reviewer (ICR): New search option for cases submitted through ICR	Digital Tools
How to enroll in electronic fund transfer for faster remittance	Digital Tools
Electronic claim response files	Digital Tools
Site-of-Care medical necessity reviews for long-acting colony-stimulating factors will not be implemented on August 1, 2021 (MAC) Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Pre-Service / Prior Authorization Clinical Review Update: July 2021 (MAC) Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
New reimbursement policy: Non-patient laboratory services - facility (MAC) Material Adverse Change (MAC)	Reimbursement Policies
Reminder: Back pain guide program, effective July 19, 2021	Products & Programs
Reminder: Updated AIM rehabilitative program, effective August 1, 2021 – and site of service reviews	Products & Programs
Anthem prior authorization updates for specialty pharmacy are available (MAC) Material Adverse Change (MAC)	Pharmacy
Certain specialty medication precertification requests may require additional documentation	Pharmacy
Reimbursement policy reminder: Inpatient readmissions	Medicare
Updates to the AIM advanced imaging clinical appropriateness guidelines	Medicare
New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing	Medicare
Prior authorization requirement changes effective September 1, 2021 – UM AROW 1845	Medicare
Let’s vaccinate Help increase your vaccination rates and close gaps-in-care with these tools and strategies	Medicare
Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428	Medicare
Medical drug benefit clinical criteria updates	Medicare
Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross and Blue Shield results in improved care management for patients	Medicare

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.

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Colorado
Provider Communications

July 2021 Anthem Provider News and Important Updates - Colorado

Drug fee schedule update

Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual

Clinical quality in practice: CME webinar series

Proper coding for in-home monitoring can make a measurable difference for INR

Company to retire Blue Precision program at the end of the year

Timely receipt of the primary payer’s EOB can help reduce timely filing denials for secondary claims

Another mark of the pandemic: An increase in childhood obesity

Working with Anthem webinars – July 2021 schedule: Anthem networks overview

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

How to enroll in electronic fund transfer for faster remittance

Electronic claim response files

Site-of-Care medical necessity reviews for long-acting colony-stimulating factors will not be implemented on August 1, 2021 (MAC)

Pre-Service / Prior Authorization Clinical Review Update: July 2021 (MAC)

New reimbursement policy: Non-patient laboratory services - facility (MAC)

Reminder: Back pain guide program, effective July 19, 2021

Reminder: Updated AIM rehabilitative program, effective August 1, 2021 – and site of service reviews

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

Certain specialty medication precertification requests may require additional documentation

Reimbursement policy reminder: Inpatient readmissions

Updates to the AIM advanced imaging clinical appropriateness guidelines

New reimbursement policy – Modifier 90: Reference (outside) laboratory and pass-through billing

Prior authorization requirement changes effective September 1, 2021 – UM AROW 1845

Let’s vaccinate

Prior authorization requirement changes effective October 1, 2021, for codes A0426 and A0428

Medical drug benefit clinical criteria updates

Attention facilities: Sending admission, discharge and transfer data to Anthem Blue Cross and Blue Shield results in improved care management for patients

ColoradoProvider Communications

July 2021 Anthem Provider News and Important Updates - Colorado

Colorado
Provider Communications