Changes to Prior Authorization Requirements

New prior authorization requirement for providers and/or material changes to contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

Medical Policies and Clinical Guidelines

  • Medical Policy and Clinical Guideline Updates -- August 2019*
  • Anthem customizations to MCG care guidelines 23rd edition*
  • Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

Reimbursement Policies

  • Reimbursement Policy Update: Bundled Services-Professional*
  • Reimbursement Policy Update: Frequency Editing-Professional*

Pharmacy Updates

  • Clinical criteria and prior authorization updates for specialty pharmacy are available*
  • REMINDER: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019

Other Important Updates

  • Medicare and Medicaid News

Featured In:
August 2019 Anthem Provider News - Indiana