Colorado
Provider Communications

September 2020 Anthem Provider News and Important Updates -- Colorado

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Title Category

Site of Care* medical necessity reviews expand to numerous surgical procedures begin December 1, 2020 (MAC)

Material Adverse Change (MAC)
Products & Programs

Predictive Analytics guide proactive support to patients undergoing chemo, resulting in lowered admissions

Products & Programs

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

Material Adverse Change (MAC)
Pharmacy

Anthem to update formulary lists for commercial health plan pharmacy benefit

Pharmacy

Anthem Chat: A fast, easy way to have your questions answered

Administrative

Working with Anthem Webinars -- September 2020 schedule: Provider Claim Questions/Issue Resolution Process Flow

Administrative

EDI Gateway Migration Deadline is September 15, 2020

Administrative

Enhanced Medical Records Submission Process to Support Claims Processing

Administrative

Patient360 Adds Care Gap Alert Feedback for Medical Providers

Administrative

Receive and respond to medical record requests for postpay audit via Change Healthcare’s Attach Assist functionality

Administrative

Commercial Risk Adjustment (CRA) Reporting Update: 2020 Prospective Program Continues

Administrative

New provider directory indicators for medication assisted treatment (MAT) providers

Administrative

National Account members living in Colorado utilizing the Pathway network

Administrative

Distinctive Procedural Services, Modifiers 59, XE, XP, XS, XU (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Frequency Editing (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
Reimbursement Policies

Medical drug benefit Clinical Criteria updates (May 2020)

Medicare

Keep up with Medicare news

Medicare
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