Colorado
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

Medical Policy and Clinical Utilization Management Guidelines notification

Material Adverse Change (MAC)
March 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Mar 1, 2023

Reimbursement policy update: Modifiers 25 and 57 - Professional

March 2023 Anthem Provider News - Colorado Reimbursement Policies Mar 1, 2023

Clinical Guidelines Notification Letter

Material Adverse Change (MAC)
February 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Feb 1, 2023

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update (MAC)

Material Adverse Change (MAC)
January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List

January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines (MAC)

Material Adverse Change (MAC)
January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update (MAC)

Material Adverse Change (MAC)
January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Cardiac Clinical Appropriateness (MAC)

Material Adverse Change (MAC)
January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines

Material Adverse Change (MAC)
January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Material Adverse Change (MAC)
January 2023 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 30, 2022

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
December 2022 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Dec 1, 2022

Reimbursement policy update: Multiple Surgery - Facility

December 2022 Anthem Provider News - Colorado Reimbursement Policies Dec 1, 2022

Reimbursement policy retirement: Acupuncture Billed with Evaluation and Management - Professional

December 2022 Anthem Provider News - Colorado Reimbursement Policies Dec 1, 2022

Improve patient outcomes for colorectal cancer screening with Labcorp’s FIT test

November 2022 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Nov 1, 2022

Updates to AIM Specialty Health cardiology clinical appropriateness guidelines CPT code list (MAC)

November 2022 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Nov 1, 2022

Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

November 2022 Anthem Provider News - Colorado Medical Policy & Clinical Guidelines Nov 1, 2022

Correction to reimbursement policy: Place of Service – facility (MAC)

November 2022 Anthem Provider News - Colorado Reimbursement Policies Nov 1, 2022

Medical Policy and Clinical UM Guidelines notification (MAC)

Material Adverse Change (MAC)
October 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Oct 1, 2022

Reimbursement policy update: Three-Dimensional (3D) Radiology Services - Professional and Facility

October 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Oct 1, 2022

Reimbursement Policy update: Multiple and Bilateral Surgery Processing - professional (MAC)

Material Adverse Change (MAC)
October 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Oct 1, 2022

Medical Policy and Clinical UM Guidelines notification (MAC)

Material Adverse Change (MAC)
September 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Sep 1, 2022

Commercial reimbursement policy update to Modifier 66: Surgical Teams - Professional

September 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Sep 1, 2022

Reimbursement policy update Assistant at Surgery (Modifiers 80, 81, 82, AS) - Professional

September 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Sep 1, 2022

Reimbursement Policy update: Modifier Rules – Professional (MAC)

Material Adverse Change (MAC)
September 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Sep 1, 2022

Enhanced reimbursement for voluntary Cancer Care Quality program to be discontinued effective December 31, 2022

July 2022 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jul 1, 2022

Medical Policy and Clinical UM Guidelines notification (MAC)

Material Adverse Change (MAC)

July 2022 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jul 1, 2022

Retraction for reimbursement policy – Sexually Transmitted Infections - professional

July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

Reimbursement policy update: Laboratory and Venipuncture Services – professional and facility (MAC)

Material Adverse Change (MAC)
July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

New Reimbursement policy: Modifier FB – professional and facility (MAC)

Material Adverse Change (MAC)
July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

New reimbursement policy: Transitional Care Management - professional

July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

Reimbursement policy update: Place of Service – facility (MAC)

Material Adverse Change (MAC)

July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

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

Material Adverse Change (MAC)
July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

Reimbursement policy update: Modifiers Rules - professional (MAC)

Material Adverse Change (MAC)
July 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2022

Updates to AIM Specialty Health musculoskeletal clinical appropriateness guidelines (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2022

Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2022

Updates to AIM Specialty Health sleep disorder management clinical appropriateness guidelines (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2022

Medical Policy and Clinical UM Guidelines notification (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2022

Updated AIM Musculoskeletal Program effective October 1, 2022: Monitored Anesthesia Care Reviews (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2022

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services -- Facility (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Jun 1, 2022

Updated use of Modifier 25 when billing for visits that include preventive services and problem-oriented evaluation and management services (MAC)

Material Adverse Change (MAC)
June 2022 Anthem Provider News and Updates - Colorado Reimbursement Policies Jun 1, 2022

Medical Policy and Clinical UM Guidelines (MAC)

Material Adverse Change (MAC)
April 2022 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Apr 1, 2022

CLARIFICATION to reimbursement policy update: Virtual Visits – professional and facility (MAC)

Material Adverse Change (MAC)
March 2022 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Mar 1, 2022

Updated preventive care guidance regarding screening colonoscopies

March 2022 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Mar 1, 2022

Updates to AIM Specialty Health outpatient rehabilitative and habilitative services (MAC)

Material Adverse Change (MAC)
March 2022 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Mar 1, 2022

Medical Policy and Clinical UM Guidelines

Material Adverse Change (MAC)
February 2022 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Feb 1, 2022

Professional reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) (MAC)

Material Adverse Change (MAC)
December 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Dec 1, 2021

New professional reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams (MAC)

Material Adverse Change (MAC)
December 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Dec 1, 2021

RETRACTION: Inpatient Facility Transfers reimbursement policy (facility)

December 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Dec 1, 2021

Reimbursement policy update: Virtual Visits - professional and facility

December 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Dec 1, 2021

Medical Policies and Clinical UM Guidelines (MAC)

Material Adverse Change (MAC)
November 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Nov 1, 2021

Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation - professional

November 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Nov 1, 2021

Medical policy and clinical UM guidelines notification – October 2021 (MAC)

Material Adverse Change (MAC)
October 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Oct 1, 2021

Reimbursement policy clarification: Claims Requiring Additional Documentation - facility

October 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Oct 1, 2021

New reimbursement policy: Multiple and Bilateral Surgery Processing – facility (MAC)

Material Adverse Change (MAC)
October 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Oct 1, 2021

Reimbursement policy update: Sexually transmitted infections testing – professional (MAC)

Material Adverse Change (MAC)
September 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2021

New reimbursement policy update: Inpatient facility transfers (MAC)

Material Adverse Change (MAC)
September 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2021

Reimbursement policy update: Drug screen testing - professional (MAC)

Material Adverse Change (MAC)
September 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Sep 1, 2021

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

Material Adverse Change (MAC)
August 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Aug 1, 2021

Reimbursement policy update: Claims requiring additional documentation (facility)

August 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Aug 1, 2021

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

Material Adverse Change (MAC)
August 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Aug 1, 2021

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

Material Adverse Change (MAC)
August 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Aug 1, 2021

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)
July 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jul 1, 2021

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

Material Adverse Change (MAC)
July 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jul 1, 2021

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

Material Adverse Change (MAC)
July 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jul 1, 2021

Medical Policy and Clinical UM Guidelines Notice (MAC)

Material Adverse Change (MAC)

June 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines Jun 1, 2021

Anthem to enhance claim edits for outpatient facility claims

June 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies Jun 1, 2021

Update to AIM Specialty Health Oncologic Imaging Clinical appropriateness guideline

May 2021 Anthem Provider News and Important Updates - Colorado Medical Policy & Clinical Guidelines May 1, 2021

Facility reimbursement policy reminder: Readmission

May 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation (facility)

May 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies May 1, 2021

Professional reimbursement policy update: Frequency Editing

May 2021 Anthem Provider News and Important Updates - Colorado Reimbursement Policies May 1, 2021

MCG Care Guidelines 25th Edition (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Apr 1, 2021

Clinic Charges (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Apr 1, 2021

Newborn Inpatient Stays (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
April 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Apr 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery Guideline

March 2021 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Mar 1, 2021

Treatment Rooms with Office Evaluation and Management Services (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Feb 1, 2021

Medical Policy and Clinical UM Guideline Updates (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Feb 1, 2021

Emergency Room Transfers (Facility Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
February 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Feb 1, 2021

Modifier Rules (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

Unit Frequency Maximum for Drugs and Biologic Substances (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

Multiple Diagnostic Imaging Procedures (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

System updates impacting Professional reimbursement policies for 2021

January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

Outpatient System updates for Facility reimbursement policies 2021

January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

MCG care guidelines 24th Edition Customization (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Jan 1, 2021

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Jan 1, 2021

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

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

Guidelines for Reporting Timed Units: Physical Medicine and Rehab Services (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
January 2021 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Jan 1, 2021

AIM Specialty Health Clinical Appropriateness Guidelines update -- Cardiology (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Advanced Imaging (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Dec 1, 2020

AIM Specialty Health Clinical Appropriateness Guidelines update -- Radiation Oncology (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Dec 1, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines

December 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Dec 1, 2020

Clinical practice and preventive health guidelines available on anthem.com

December 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Dec 1, 2020

Expenses Included in Facility Services (Professional Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
December 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Dec 1, 2020

Bundled Services and Supplies (Professional Reimbursement Policy) -- Update

December 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Dec 1, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Nov 1, 2020

REMINDER: Post-service reviews using AIM

November 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Nov 1, 2020

Documentation Standards for Episodes of Care (Professional Reimbursement Policy) -- New (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Nov 1, 2020

Modifier Rules (Professional Reimbursement Policy) -- Update (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Nov 1, 2020

Bundled Services and Supplies (Professional Reimbursement Policy) – Update (MAC)

Material Adverse Change (MAC)
November 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Nov 1, 2020

Claims editing update for ICD-10-CM Excludes 1 notes

November 2020 Anthem Provider News and Important Updates -- Colorado Reimbursement Policies Nov 1, 2020

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

October 2020 Anthem Provider News and Important Updates -- Colorado Medical Policy & Clinical Guidelines Oct 1, 2020
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