Anthem Blue Cross and Blue Shield reviews and updates our online provider manuals annually. The updated provider manual is now available on the Answers@Anthem page of the Georgia anthem.com/provider website. 

Atlanta
Tuesday, April 9, 2019

9:00–10:30 a.m.

Breakfast will be provided

 

Emory, North Decatur

2701 North Decatur Road

Decatur, GA 30030

 

The theatre is on the ground floor of the main hospital. Take the A elevator to the ground floor, turn left and follow the signs for the theatre/auditorium.

  

Please R.S.V.P. by Wednesday, April 3rd  to RSVPBlue@anthem.com. Include the name of the facility or practice, and the names and e-mail addresses of those attending.

Athens
Tuesday, May 7, 2019

9:30–11:00 a.m. 

St. Mary’s Healthcare

Flowers STE

1230 Baxter Street

Athens, GA. 30606

 

Please R.S.V.P. by Thursday, May 2nd  to RSVPBlue@anthem.com. Include the name of the facility or practice, and the names and e-mail addresses of those attending.

 

 

Columbus
Thursday, May 16, 2019

11:30 – 1:30 p.m.

Lunch will be provided

 

Anthem
6087 Technology Parkway
Midland, GA 31820

 

Please R.S.V.P. by Friday, May 11th  to RSVPBlue@anthem.com. Note: seating is limited, please only allow two from your office to attend.  Be sure to include the name of the facility or practice, and the names and e-mail addresses of those attending with your R.S.V.P.

Additional Provider Town Halls with dates to be determined will be held in the following Georgia cities:

• Augusta 
• Macon 
• Rome 
• Savannah

Exact Sciences offers Cologuard, a non-invasive colorectal cancer screening test and they are one of the many labs in the Anthem Blue Cross and Blue Shield PPO laboratory network. Exact Sciences is an out-of-network laboratory for HMO, Open Access Point of Service (POS). Cologuard can only be covered for these networks if preauthorization is obtained in advance. 

 

Laboratory Corporation of America (LabCorp) is the exclusive clinical reference laboratory provider for Anthem Blue Cross and Blue Shield HMO and Open Access POS members. This means that HMO and Open Access POS members should be referred to LabCorp.  

 

LabCorp offers several options for colorectal cancer screening including the Occult Blood Fecal Immunoassay (iFOBT). If you have questions about LabCorp services including colorectal cancer screening tests, please call LabCorp at 800-762-0890.

Applied Behavioral Analysis (ABA) therapy benefits are now available to Anthem Publix account members. The ABA therapy program is designed to assist members and families who have children with autism spectrum diagnosis (ASD).

 

ABA therapy benefits are managed by a dedicated coordinator through the Publix benefit plan case management program, which is administered by Companion Benefit Alternatives (CBA).

 

ABA therapy covers specific services for members with ASD. ABA involves a treatment team made up of a certified technician and a qualified health professional (typically a board-certified behavioral analyst or a board-certified assistant behavioral analyst) to provide behavioral therapy.

 

Although the ABA therapy program does not include speech, physical or occupational therapy, these benefits are covered under the Publix medical plan.

 

Prior authorization required

Prior authorization by CBA is required for ABA services. An initial request for ABA therapy requires a treatment plan, signed and submitted by a licensed physician.

 

Anthem will not provide coverage for ABA therapy services until you receive approval through the prior authorization review process.

 

For detailed prior authorization requirements, or for more information about ABA therapy benefits, contact the ABA project coordinator at 800-868-1032, ext. 25634 or

autismsupport@companiongroup.com.

In a continuation of our CRA reporting update in March 2019, Anthem requests your assistance with respect to our Commercial Risk Adjustment (CRA) reporting processes. There are two approaches that we take (Retrospective and Prospective) that work to improve risk adjustment reporting accuracy.  We are focusing on performing appropriate interventions and chart reviews for patients with undocumented Hierarchical Condition Categories (HCC), to close the documentation and coding gaps that we are seeing with our members enrolled in our Affordable Care Act (ACA) compliant plans.

 

With both our Prospective and Retrospective approaches, accurate documentation and coding are what we are encouraging physicians to achieve. As a physician for our members with ACA compliant plans, you play a vital role in the success of our CRA reporting processes and ACA compliance. When members visit your office, we encourage you to document ALL of the members’ health conditions, especially chronic diseases on the claim.  As a result, there will be ongoing documentation that indicates these conditions are being properly assessed and managed. Additional benefits of accurate coding include:

• Reduced volume in medical chart requests in the future due to the increased level of specificity in documentation and coding, as part of our Retrospective approach; and 
• Reduced volume of health assessment requests by ensuring your patients with our ACA compliant plans are seen for their annual exams each and every year, as part of our Prospective approach.

 

Please Note: It’s important to ensure that all diagnosis codes captured in your EMR system are included on the claims, and are not being truncated by your claims software management system. For example, some EMR systems may capture up to 12 diagnosis codes, but a claim system may only have the ability of capturing 4. If your claim system is truncating some of the listed diagnosis codes, please work with your vendor/clearing house to ensure all codes are being captured.

 

Reminder about ICD-10 CM coding

As you may be aware, the ICD-10 CM coding system serves multiple purposes including identification of diseases, justification of the medical necessity for services provided, tracking morbidity and mortality, and determination of benefits. Additionally, Anthem uses ICD-10 CM codes submitted on health care claims to monitor health care trends and costs, disease management and clinical effectiveness of medical conditions.

 

We encourage you to follow the principles below for diagnostic coding to properly demonstrate medical necessity and complexity:

• Code the primary diagnosis, condition, problem or other reason for the medical service or procedure in the first diagnosis position of the claim whether on a paper claim form or the 837 electronic claim transaction, or point to the primary diagnosis by using the correct indicator/pointer.
• Include any secondary diagnosis codes that are actively managed during a face-to-face, provider-patient encounter, or any condition that impacts the provider’s overall management or treatment of that patient in the remaining positions. 
• Include all chronic historical codes, as they must be documented each year under the ACA.  (E.g. an amputee must be coded each and every year even if the visit is not addressing the amputated limb specifically).

You want what’s best for your patients’ health. So, it's challenging when a patient doesn't follow your prescribed treatment plan.  Why do approximately 50% of patients with chronic illness stop taking their medications within one year of being prescribed1? What can be done differently? The missed opportunity may be that you’re only seeing and hearing the tip of the iceberg—the observable portion of the thoughts and emotions your patient is experiencing.  The barriers that exist under the waterline — the Titanic-sized, often invisible, patient self-talk that may not get discussed — can create a misalignment between patient and provider.

So we’ve created an online learning experience for the skills and techniques that may help you navigate these uncharted patient waters. After completing the learning experience you’ll know how to see the barriers, use each appointment as an opportunity to build trust, and bring to light the concerns that may be occurring beneath the surface of your patient interactions. Understanding and addressing these concerns may help improve medication adherence—and you’ll earn CME credit along the way.

Take the next step. Go to MyDiversePatients.com and review The Medication Adherence Iceberg: How to navigate what you can’t see to enhance your skills. The course is approximately one hour and accessible by smart phone, tablet or desktop at no cost.

1 Centers for Disease Control and Prevention. (2017, Feb 1). Overcoming Barriers to Medication Adherence for Chronic Conditions.  Retrieved from https://www.cdc.gov/cdcgrandrounds/archives/2017/february2017.htm

In February, Anthem introduced a new feature on Interactive Care Reviewer (ICR) that lets you request a clinical appeal for denied authorizations. Now instead of making a phone call or sending a fax you can save time making your request online! This feature is available for authorization requests that were submitted through ICR, phone or fax.                                                                                                                                          

Here’s how easy it is to request a clinical appeal using ICR:

Logon to ICR from the Availity Portal and locate the case from ICR’s dashboard - My Organization Requests or through Check Case Status if the case was submitted by phone or fax.

• Select the Request Tracking ID link to open the case. If the case is eligible for an appeal you will see the Request Appeal menu option on the Case Overview screen.
• Select Request Appeal to open the Appeal Details screen and complete the required fields on the appeal template. (You also have the option of uploading attachments and images to support your request.)
• Select Submit.

Want to check the status of your clinical appeal?

The Check Appeal Status feature was added to ICR in December 2018.

• Select Check Appeal Status from the ICR top menu bar.
• Type the Appeal Case ID and Member ID in the allocated fields (do not include the alpha/numeric prefix).
• Select Submit.

The appeal status and detail of the decision will open on the bottom of the screen. Additionally, you will be able to access letters associated with the appeal.

 

Need more information on how to navigate the new ICR Appeals features?

Download the ICR Clinical Appeals Reference Guide located on the Availity Portal. Select: Payer Spaces | Applications | Education and Reference Center | Communication and Education. Find the link to the reference guide below the ICR menu.

 

Additional Training:

If you are new to ICR or want to get a refresher please attend our monthly ICR webinar. Register here for the April webinar.

 

We continually update our provider directories to help ensure that your current practice information is available to our members. At least 30 days prior to making any changes to your practice – updating address and/or phone number, adding or deleting a physician from your practice, etc. – please notify us by completing the Anthem Provider Maintenance Form located on the Provider Forms page of our anthem.com/provider website. Thank you for your help and continued efforts to keep our records up to date.

As part of our commitment to provide you with the latest clinical information and educational materials, we have adopted nationally recognized medical, behavioral health, and preventive health guidelines, which are available to providers on our website. The guidelines, which are used for our Quality programs, are based on reasonable medical evidence, and are reviewed for content accuracy, current primary sources, the newest technological advances and recent medical research. All guidelines are reviewed annually, and updated as needed. The current guidelines are available on the Health & Wellness page of our provider website.

 

Preapproval changes are listed in the attached PDF titled “GA Preapproval List Change Notification 4.1.2019”. For additional information, you can access the complete Georgia Standard Preapproval List, Georgia Standard Preapproval CODE List and Georgia Standard Adopted Clinical Guideline List using the following links:

• Georgia Standard Preapproval List
• Georgia Standard Preapproval CODE List
• Georgia Standard Adopted Clinical Guideline List

See attached PDF titled “GA Preapproval List Change Notification 4.1.2019”.

The Medical Policy and Technology Assessment Committee adopted new and/or revised Medical Policies and Clinical Guidelines outlined in the attached PDF. 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 Blue Cross and Blue Shield and all the Medical Policies are available at the Anthem Blue Cross and Blue Shield website. Please note our medical policies now include NOC (Not Otherwise Classified) codes to expedite the process of determining services that may require medical review. If you don’t 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–Friday from 8 AM to 7 PM or send written requests (specifying medical policy or guideline of interest, your name and address to where information should be sent) to:

 

 

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 Medical Policy and Technology Assessment Committee (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 PDF titled “GA medical policy and clinical guideline updates 4.1.19” to view the list of new and/or revised medical policies and clinical guidelines.

Effective for dates of service on and after June 29, 2019, the following updates will apply to the AIM Advanced Imaging of the Head and Neck Clinical Appropriateness guidelines. 

 

Sinusitis/rhinosinusitis:

• Expanded the scope of complicated sinusitis
• Defined a minimal treatment requirement for uncomplicated sinusitis
• Identified reasons for repeat sinus imaging, aligned with Choosing Wisely
• Subacute sinusitis to be treated as more like acute or chronic rhinosinusitis based on the AAO-HNS acute sinusitis guideline
• Defined indications for preoperative planning for image navigation following a clinical policy statement on appropriate use from the AAO-HNS
• Removed CT screening for immunocompromised patients

Infectious disease – not otherwise specified:

• Added MRI TMJ to this indication

Inflammatory conditions – not otherwise specified:

• Allow MRI TMJ for suspected inflammatory arthritis following radiographs

Trauma:

• Radiograph requirement for suspected mandibular trauma
• MRI TMJ in trauma for suspected internal derangement in surgical candidates

Neck mass (including lymphadenopathy):

• Align adult neck imaging guideline with AAO-HNS guideline
• Expand definition of neck mass beyond palpable (seen on laryngoscopy)
• Allow imaging for pediatric neck masses when initial ultrasound is not diagnostic

Parathyroid adenoma:

• Further defined the patient population that needs evaluation
• Removed the requirement for aberrant anatomy in preoperative planning
• Position CT as a diagnostic test after both ultrasound and parathyroid scintigraphy
• Remove MRI as a modality to evaluate based on lack of evidence

Temporomandibular joint dysfunction:

• Removed standalone “frozen jaw” indication
• Allow ultrasound in addition to radiographs as preliminary imaging
• Allow advanced imaging without preliminary radiographs or US in the setting of mechanical signs or symptoms
• Changed “Panorex” to “Radiographs” to allow for TMJ radiographs
• Added requirement for conservative treatment and planned intervention for suspected osteoarthritis

Cerebrospinal fluid (CSF) leak of the skull base:

• Added modalities and criteria to evaluate for CSF leak

Dizziness or vertigo:

• Add Tullio’s phenomenon for lateral semicircular canal dehiscence
• Expand definition of abnormal vestibular function testing

Hearing loss:

• Added indication for sudden onset hearing loss in adult patients
• More clearly delineated appropriate modalities based on types of hearing loss in pediatric patients
• Allow either CT or MRI for mixed hearing loss

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal_SM 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 program does not apply to FEP.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines here.

Effective for dates of service on and after June 29, 2019, the following updates will apply to the AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart and AIM Clinical Appropriateness Guidelines for Arterial Ultrasound. 

Advanced Imaging of the Heart

• Resting Transthoracic Echocardiography (TTE)
  • Changes made to address frequency of surveillance of LV function for cardio-oncology.
• TTE
  • Changes made to address frequency of surveillance echocardiography following transcatheter mitral valve repair. These recommendations follow CMS guidelines.

Arterial ultrasound

• Upper extremity arterial duplex
  • Indication added for creation of arteriovenous (AV) fistulae for dialysis
• Lower extremity arterial duplex
  • ACC guideline for management of peripheral arterial disease (2016) indicates that Duplex imaging should be performed only after the decision to revascularize has been made. There is no role for duplex imaging in the initial diagnosis of peripheral arterial disease. The current AIM guideline is not aligned with this position and the proposed changes address that malalignment.
  • Language changed to account for the fact that critical limb ischemia should include patients with non-healing ulcers and gangrene

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal_SM 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 program does not apply to FEP.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines here.

Effective for dates of service on and after June 29, 2019, the following updates will apply to the AIM Sleep Disorder Management Clinical Appropriateness Guidelines. 

• Reconfigured structure of BPAP with and without back-up rate feature criteria for patients with established central sleep apnea (CSA)
• Removed the criteria to try rate support for CSA

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal_SM 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 program does not apply to FEP.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines here.

Effective for dates of service on and after June 29, 2019, the following updates will apply to the AIM Joint Surgery Clinical Appropriateness Guidelines. 

General Requirements

• Conservative management: For joint arthroplasty, clarification of conservative management options provide allowance for conservative management exception. Add intraarticular corticosteroid injections as an option. Remove ice or heat given that it is commonly performed in all patients and hence does not meet the threshold for a non-operative management modality as intended. Addition of physical therapy or home therapy requirement for all non-arthroplasty joint procedures based on preponderance of benefit over harm to conservative care. Remove MOON protocol conservative care requirement throughout the document based on feasibility and standards of practice
• Reporting of symptom severity: Inability felt too restrictive to allow for difficulty performing
• Tobacco Cessation: removed nicotine-free documentation requirement

Subacromial Impingement Syndrome (without Rotator Cuff Tear) Cervical Decompression with or without Fusion

• Drop Arm Test removed due to lack of diagnostic accuracy for subacromial impingement

Synovectomy/Debridement

• New indication for synovectomy/debridement based on review of the evidence and common clinical scenarios

Tendinopathy of the Long Head of the Biceps – Tenodesis or Tenotomy

• Allows both techniques based on no evidence for net benefit of one over the other
• Allow a broader range of clinical symptoms and a lower threshold for imaging evidence of tendinopathy , no requirement for MR evidence as tendinopathy can be a clinical diagnosis

Primary Total Hip Arthroplasty

• Addition of fracture management and hip arthrodesis

Revision Total Hip Arthroplasty

• Addition of appropriate clinical scenarios based on clinical practice experience and evidence, align terminology to that used in the literature

Resection Arthroplasty of the Hip, Femoral Head Ostectomy, or Girdlestone Resection Arthroplasty

• Addition of appropriate clinical scenarios based on clinical practice experience (limited evidence)

Hip Arthroscopy

• Expanded appropriate techniques for FAI surgery to include acetabuloplasty and femoroplasty

Arthroscopic Treatment of FAIS

• Radiographic and clinical criteria added to include symptoms related to FAI and the likelihood that surgery will be successful

Elective Patellofemoral Arthroplasty

• New guideline for patellofemoral arthroplasty, a unicompartmental procedure based on evidence and standards of practice

Revision of Prior Knee Arthroplasty

• Addition of appropriate clinical scenarios based on clinical practice experience and evidence, align terminology to that used in the literature

Meniscal Repair or Meniscectomy 

• Conservative requirement for degenerative meniscus tears
• Definition of acute meniscal tear and symptomatology
• More restrictive use of partial meniscectomy associated with osteoarthritis and degenerative tears

Arthroscopically assisted lysis of adhesions

• New guideline based on evidence and clinical consensus

Manipulation under anesthesia

• New guideline based on evidence and clinical consensus

In-Office Diagnostic Arthroscopy (mi-eye 2™)

• Not medically necessary based on lack of evidence for net benefit

Meniscal Allograft Transplantation of the Knee

• Collagen meniscal implants are considered not medically necessary

Treatment of Osteochondral Defects

• New criteria for talar OCD based on lesion size and prior procedures

Autologous chondrocyte implantation (ACI)

• Allow patellar surface ACI based on evidence for non-inferiority relative to trochlear surface lesions

CPT Code additions

• CPT codes 27120, 27122, 27437, 27445, 27488, 29871, G0428, 28446, and 29892

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal_SM 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 program does not apply to FEP.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines here.

Beginning with dates of service on or after July 1, 2019, Anthem will implement the new facility reimbursement policy, Partial Hospitalization Program and Intensive Outpatient Program Services. This policy applies a limit of one (1) unit of service per day for partial hospitalization program and/or intensive outpatient programs. For more information about this new policy, visit the Reimbursement Policy page at anthem.com/provider website.

Effective July 1, 2019, Anthem will require medical necessity review for rehabilitative (restoring function) and habilitative (enhancing function) services for fully insured members. AIM Specialty Health® (AIM), a separate company, will manage these therapy service reviews.

 

AIM will manage these Physical Therapy (PT), Occupational Therapy (OT) and Speech Therapy (ST) medical necessity reviews using the following Anthem Clinical UM Guidelines: CG-REHAB-04 Physical Therapy, CG-REHAB-05 Occupational Therapy, and CG-REHAB-06 Speech-Language Pathology Services.  Please note, this does not apply to procedures performed in an inpatient or observation setting, or on an emergent basis. The clinical criteria to be used for these reviews can be found on the Anthem provider website Clinical UM Guidelines page. A complete list of CPT codes requiring prior authorization for the AIM Rehabilitative program is available on the AIM Rehabilitation microsite. There you can learn more about the program and access helpful information and tools such as order entry checklists and FAQs.

 

AIM will begin accepting prior authorization requests on June 17, 2019 for dates of service on and after July 1, 2019. To determine if prior authorization review is needed for an Anthem member, please check online or call the prior authorization review number located on the back of the member ID card. The program will be offered to new local self-funded accounts (ASO) to add to their members’ benefit package as of July 1, 2019.

 

Ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal_SM 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.

 

AIM Rehabilitation training webinars                                                                     

Anthem invites you to take advantage of a free informational webinar that will introduce you to the program and the robust capabilities of the AIM ProviderPortal_SM.  Go to the AIM Rehabilitation microsite to register for an upcoming webinar. If you have previously registered for other services managed by AIM, there is no need to register again. The training will be recorded and can be viewed at a time convenient for you!

Anthem has identified that providers often bill a duplicate Evaluation and Management (E/M) service on the same day as a procedure even when the same provider (or a provider with the same specialty within the same group TIN) recently billed a service or procedure which included an E/M for the same or similar diagnosis. The use of modifier 25 to support separate payment of this duplicate service is not consistent with correct coding or Anthem’s policy on use of modifier 25. 
 

Beginning with claims processed on or after May 1, 2019 Anthem may deny the E/M service with a modifier 25 billed on the day of a related procedure when there is a recent service or procedure for the same or similar diagnosis on record.

If you believe a claim should be reprocessed because there are medical records for related visits that demonstrate an unrelated, significant and separately identifiable E/M service, please submit those medical records for consideration.

75975MUPENMUB 02/19/2019

CPT Category II codes are supplemental tracking codes used to support quality patient care and performance management. CPT II codes are:

• Billed in the procedure code field in the same way as CPT Category I codes.
• Used to describe clinical components usually included in evaluation, management or clinical services.
• Billed with a $0 billable charge amount since they are not usually associated with any relative value.

 

Under this new incentive program, Anthem will reimburse contracted Medicare Advantage providers for submitting select HEDIS® related CPT Category II codes for eligible members.

Using these CPT Category II codes for Medicare Advantage members will:

• Help providers address clinical care opportunities.
• Facilitate timely and accurate claims payments.

 

Detailed information about this program, including a list of applicable codes, will be sent to providers.

ABSCARE-0006-19

75975MUPENMUB 02/19/2019

Please continue to check Important Medicare Advantage Updates at anthem.com/medicareprovider for the latest Medicare Advantage information, including:

• Revision to Facility Emergency Department Reimbursement Policy  
• Prior authorization requirements for DME repair and portable oxygen  
• Medical Policies and Clinical Utilization Management Guidelines update
• Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ
• Group Retiree members and National Access Plus
• New provider learning opportunity: Put the AIM ProviderPortal to work for you
• New provider service phone number beginning January 1, 2019

 

75975MUPENMUB 02/19/2019