Products & Programs PharmacyCommercialJuly 1, 2021

Update: site of care medical necessity reviews for long-acting colony-stimulating factors will no longer go into effect on August 1, 2021

This is an update to the article published in the April 2021 edition of Provider News regarding Site of Care medical necessity reviews for long-acting colony-stimulating factors.

 

The program will no longer begin on August 1, 2021.

 

Please see below for the complete updated notice.

This service will no longer be in effect on or after August 1, 2021 for medical necessity review of the site of care that was to be required for the following long-acting colony-stimulating factors for oncology indications for Anthem commercial plan members.

  • Neulasta® & Neulasta Onpro® (pegfilgrastim)
  • Fulphila® (pegfilgrastim-jmdb)
  • Udenyca® (pegfilgrastim-cbqv)
  • Ziextenzo® (pegfilgrastim-bmez)
  • Nyvepria™ (pegfilgrastim-apgf)

 

Submit a request for review

There will be no changes for ordering providers whom submit prior authorization requests for the hospital outpatient site of care for these medications for dates of service on or after August 1, 2021 to AIM in one of the following ways:

  • Access AIM ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
  • Access AIM via the Availity web portal at availity.com
  • Call the AIM contact center toll-free number: 866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET.

 

Please note, this review does not apply to the following plans: BlueCard®, Federal Employee Program® (FEP®), Medicaid, Medicare Advantage, Medicare supplemental plans. Providers can view prior authorization requirements for Anthem Blue Cross and Blue Shield (Anthem) members on the clinical criteria webpage.

 

Providers should continue to verify eligibility and benefits for all members prior to rendering services.

 

If you have questions, please call the provider service phone number on the member’s ID card.  

 

Note: In some plans “level of care” or another term such as “setting” or “place of service” may be the term used in benefit plans, provider contracts or other materials instead of or in addition to “site of care” and in some plans, these terms may be used interchangeably. For simplicity, we will hereafter use “site of care.”

 

1210-0721-PN-GA

PUBLICATIONS: July 2021 Anthem Provider News - Georgia