Medical policy and clinical guideline updates 4/1/2021
NOTE: Any clinical guideline included in this standard MPTAC notification is only effective for GA if included on the GA standard adopted clinical guideline list unless there is a group-specific review requirement in which case it will be considered ‘adopted’ for that group only and for the specific type of review required. Additionally, as part of the pre-payment review program for commercial or Federal Employee Health Benefits Program (FEHBP) plans, clinical guidelines approved by MPTAC but not included in the GA standard adopted clinical guideline list may be used to review a provider’s claims when a provider’s billing practices are not consistent with other providers in terms of frequency or in some other manner or for provider education and are “adopted” for those purposes.
Open the attached document titled “GA medical policy and clinical guideline updates 4.1.2021” to view the new and/or revised medical policies and clinical guidelines adopted by the Medical Policy and Technology Assessment Committee.
To view medical policies and utilization management guidelines applicable to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program® (FEP®)), please visit fepblue.org > policies & guidelines.
April 2021 Anthem Provider News - Georgia