Georgia
Provider Communications

December 2018 BCBSGa Provider Newsletter

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Title	Category
About our Network eUPDATE email tool	Administrative
2019 BCBSGa provider Town Hall meeting schedule	Administrative
Availity to serve as EDI entry point for electronic submissions	Administrative
Company works to simplify payment recovery process for National Accounts membership	Administrative
Request an appeal using Interactive Care Reviewer (ICR)	Administrative
Integrated Care Model for plans purchased on the Health Insurance Marketplace benefits patients and physicians	Administrative
Coordination of care	Administrative
Important information about utilization management	Administrative
Members’ rights and responsibilities	Administrative
Vaginal Birth after Cesarean (VBAC) certified shared decision making aid available on the web	Administrative
Clinical practice and preventive health guidelines available on anthem.com	Administrative
Coordination of Benefits for an FEP® member	Administrative
2019 FEP Benefit information available online	Administrative
HEDIS® 2018 commercial results are in	Administrative
Use the Provider Maintenance Form to update your practice information	Administrative
Clinical Practice and Preventive Health guidelines available on the web	Administrative
Introducing SmartShopper, the consumer shopping and savings program for medical care SmartShopper is an incentive and engagement program that activates members to change behavior and shop for health care.	Products & Programs
Case Management Program	Products & Programs
ConditionCare Program benefits patients and physicians	Products & Programs
Benefit change for Infliximab for Federal Employee Program	Pharmacy
Introducing the new Clinical Criteria page for injectable, infused or implanted drugs	Pharmacy
BCBSGa accepts electronic prior authorization requests for prescription medications online	Pharmacy
Pharmacy information available on anthem.com	Pharmacy
“Rule of Eight” Reporting Guidelines for Physical Medicine and Rehabilitation Services (Professional)	Medical Policy & Clinical Guidelines
System updates for 2019 (Professional)	Policy Updates
Coding tip: Claims processed with modifier 79 should be reported by the same health care professional	Policy Updates
Bundled services and supplies (Professional)	Reimbursement Policies
Reimbursement for convenience surgical supply kits (Professional)	Reimbursement Policies
Scope of License reimbursement policy update (Professional)	Reimbursement Policies
Updates to AIM musculoskeletal surgery clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Update to AIM clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Restructure of AIM advanced imaging clinical appropriateness guidelines	Medical Policy & Clinical Guidelines
Notification of preapproval list changes (December 2018)	Policy Updates
Anthem Blue Cross and Blue Shield Georgia Medical Policy and Clinical Guideline Updates 12/1/2018	Medical Policy & Clinical Guidelines
New Medicare Advantage provider service phone number beginning January 1, 2019	Medicare
2019 Medicare Advantage individual benefits and formularies	Medicare
CMS Medicare Preclusion List effective April 1, 2019	Medicare
When and how to initiate Medicare Advantage reopenings	Medicare
Individual Medicare plans move compound drugs off formulary beginning January 1, 2019	Medicare
Medicare Part B drugs may include Step Therapy beginning January 1, 2019	Medicare
Medical Policies updated	Medicare
Keep up with Medicare news	Medicare

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.