Connecticut
Provider Communications

September 2020 Anthem Connecticut Provider News

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Title Category

Site of care medical necessity reviews expands to additional surgical procedures beginning December 1, 2020

Products & Programs

Formulary lists updated for commercial health plan pharmacy benefit

Pharmacy

Specialty pharmacy updates effective December 2020

Pharmacy

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

Administrative

Interactive Care Reviewer self-service, online prior authorization tool now available for Anthem and FEP membership

Administrative

EDI Gateway migration deadline is September 15, 2020

Administrative

Patient360 adds care gap alert feedback for medical providers

Administrative

Enhanced medical records submission process to support claims processing

Administrative

BlueCare Prime HMO Plans’ PCP referral requirements

Administrative

Important State of Connecticut Employer Group, Connecticut Partnership Plan changes

Administrative

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

Administrative

Commercial Risk Adjustment (CRA) reporting update: 2020 prospective program continues

Administrative

Reimbursement policy update: Distinct Procedural Services - Modifiers 59, XE, XP, XS, XU - professional

Reimbursement Policies

Reimbursement policy update: Frequency Editing - professional

Reimbursement Policies

Medical drug benefit clinical criteria updates

Medicare

Update: Notice of changes to the AIM musculoskeletal program

Medicare

Keep up with Medicare news

Medicare
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