Medical Policies and Clinical Guidelines updates

The Medical Policy and Technology Assessment Committee (MPTAC) adopted the following new and/or revised Medical Policies and Clinical Guidelines. Some may have expanded rationales, medical necessity indications, or criteria, and some may involve changes to policy position statements that might result in services that previously were covered being found to be either not medically necessary or investigational/not medically necessary. Clinical Guidelines adopted by Anthem and all the Medical Policies are available here. Please note our Medical Policies now include not otherwise classified (NOC) codes to expedite the process of determining services that may require medical review.

If you do not have access to the Internet, you may request a hard copy of a specific Medical or Behavioral Health Policy or Clinical UM Guideline by calling Provider Services at 800-241-7475, Monday through Friday, from 8 a.m. to 7 p.m. You may also send written requests (specifying the policy or guideline of interest, your name, and address to where information should be sent) to:

Anthem                      
Attention: Prior Approval
Mail code GAG009-0002                              
3350 Peachtree Road NE                              
Atlanta, GA 30326                   

Note: Any Clinical Guideline included in this standard MPTAC notification is only effective for Georgia if included on the Georgia Standard Adopted Clinical Guideline list unless there is a group-specific review requirement. In this 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 on the Georgia 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. They are considered adopted for those purposes.