Georgia
Provider Communications

December 2018 BCBSGa Provider Newsletter

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Title Category

2019 BCBSGa provider Town Hall meeting schedule

Administrative

2019 FEP Benefit information available online

Administrative

2019 Medicare Advantage individual benefits and formularies

Medicare

About our Network eUPDATE email tool

Administrative

Anthem Blue Cross and Blue Shield Georgia Medical Policy and Clinical Guideline Updates 12/1/2018

Medical Policy & Clinical Guidelines

Availity to serve as EDI entry point for electronic submissions

Administrative

BCBSGa accepts electronic prior authorization requests for prescription medications online

Pharmacy

Benefit change for Infliximab for Federal Employee Program

Pharmacy

Bundled services and supplies (Professional)

Reimbursement Policies

Case Management Program

Products & Programs

Clinical practice and preventive health guidelines available on anthem.com

Administrative

Clinical Practice and Preventive Health guidelines available on the web

Administrative

CMS Medicare Preclusion List effective April 1, 2019

Medicare

Coding tip: Claims processed with modifier 79 should be reported by the same health care professional

Policy Updates

Company works to simplify payment recovery process for National Accounts membership

Administrative

ConditionCare Program benefits patients and physicians

Products & Programs

Coordination of Benefits for an FEP® member

Administrative

Coordination of care

Administrative

HEDIS® 2018 commercial results are in

Administrative

Important information about utilization management

Administrative

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Integrated Care Model for plans purchased on the Health Insurance Marketplace benefits patients and physicians

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

Introducing the new Clinical Criteria page for injectable, infused or implanted drugs

Pharmacy

Keep up with Medicare news

Medicare

Medical Policies updated

Medicare

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

Members’ rights and responsibilities

Administrative

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

Notification of preapproval list changes (December 2018)

Policy Updates

Pharmacy information available on anthem.com

Pharmacy

Reimbursement for convenience surgical supply kits (Professional)

Reimbursement Policies

Request an appeal using Interactive Care Reviewer (ICR)

Administrative

Restructure of AIM advanced imaging clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Scope of License reimbursement policy update (Professional)

Reimbursement Policies

System updates for 2019 (Professional)

Policy Updates

Update to AIM clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Updates to AIM musculoskeletal surgery clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Use the Provider Maintenance Form to update your practice information

Administrative

Vaginal Birth after Cesarean (VBAC) certified shared decision making aid available on the web

Administrative

When and how to initiate Medicare Advantage reopenings

Medicare

“Rule of Eight” Reporting Guidelines for Physical Medicine and Rehabilitation Services (Professional)

Medical Policy & Clinical Guidelines
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