Connecticut
Provider Communications

July 2019 Anthem Connecticut Provider News

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Title Category

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines

Products & Programs

Clinical criteria updates for specialty pharmacy

Pharmacy

Clinical criteria coding updates for specialty pharmacy

Pharmacy

Update to provider/facility UM reimbursement penalties and corresponding update to Provider/Facility Manual

Administrative

Clinical validation - professional

Administrative

Payment recovery process simplified for National Accounts membership

Administrative

Commercial Risk Adjustment (CRA) Reporting Update: 2019 Program Year Progression

Administrative

Make the move to the Availity EDI Gateway today

Administrative

State-supplied vaccines reminder - professional

Administrative

Modifier 79 reminder - professional

Administrative

Modifier 63 reminder - professional

Administrative

ICD-10-CM coding guidelines and laterality - professional

Administrative

Un-adopted clinical guidelines effective June 1, 2019

Medical Policy & Clinical Guidelines

Federal Employee Health Benefit Program® (FEP) PPO members will now require prior approval for specific specialty drugs and site of care

Federal Employee Plan (FEP)

Electronic claim payment reconsideration

Medicare

Sepsis diagnosis coding and billing reminder

Medicare

Home health billing guidelines for contracted providers

Medicare

Outpatient Rehabilitation Program transitioning to AIM

Medicare

Keep up with Medicare news

Medicare
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