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.

Changes to Prior Authorization Requirements


  • Medical Policy/Clinical Guidelines Updates – February 2019*


  • Reimbursement Policy Updates – February 2019*


  • Clinical criteria updates for specialty pharmacy*


  • Specialty pharmacy prior authorization list expansion*


  • Specialty pharmacy medical step therapy drug list expansion*


Other Important Updates


  • Professional billing - Update regarding E/M with modifier 25


  • Medicare and Medicaid updates

Featured In:
February 2019 Anthem Indiana Provider Newsletter