Colorado
Provider Communications

October 2020 Anthem Provider News and Important Updates -- Colorado

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Title Category

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

Material Adverse Change (MAC)
Pharmacy

Anthem updates formulary lists for commercial health plan pharmacy benefit

Pharmacy

Commercial Risk Adjustment (CRA) Reporting Update: New guidance on telephone-only service CPT codes

Administrative

Drug fee schedule update

Administrative

Electronic member ID cards available on the Availity Portal

Administrative

FDA approvals and expedited pathways used -- New Molecular Entities (NMEs)

Pharmacy

Federal Employee Program® Expands Specialty Pharmacy Prior Authorization List (MAC)

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

Keep up with Medicare news

Medicare

Laboratory and Venipuncture Services (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Medical drug benefit Clinical Criteria updates (June 2020)

Medicare

National Accounts 2021 Pre-certification list

Administrative

Network Relations Team Updates -- Colorado

Administrative

New Blue HPN® network included in plans available for employee open enrollment Fall 2020

Administrative

New Medical Claim Attachment Webinars: Register Today

Administrative

New Pathway Essentials network in Colorado to support new product offerings available in January 1, 2021

Administrative

Patient360 enhancement for medical providers

Medicare

Pharmacy information available on anthem.com

Pharmacy

Prior authorization requirements for the below codes

Medicare

Provider transparency update

Medicare

Reimbursement policy update -- Claims Requiring Additional Documentation policy (Facility)

Reimbursement Policies

REMINDER: Expansion of AIM Musculoskeletal Program Effective November 1, 2020

Medical Policy & Clinical Guidelines

Social determinants of health support expanding with GroundGame Health

Medicare

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines delayed

Medical Policy & Clinical Guidelines

Update: Notice of changes to the AIM musculoskeletal program

Medicare

Updated Coverage for Breast Cancer prevention medications

Pharmacy

What Matters Most: Improving the Patient Experience

Administrative

Working with Anthem Webinars -- October 2020 schedule: Pathway Essentials

Administrative
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