Notice of Changes to Prior Authorization Requirements -- July 2019

Changes to Prior Authorization Requirements and/or Material Changes to Contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

Clinical Guidelines

• Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

 

Reimbursement

• Clinical Validation: Professional*
• Update to Provider UM reimbursement penalties and corresponding update to Provider Manual*

 

Other Important Updates

• Pharmacy: Clinical Criteria updates for specialty pharmacy
• FEP: Anthem Federal Employee Health Benefit Program^® (FEP) PPO Members will now require prior approval for specific Specialty Drugs and Site of Care

 

Medicare and Medicaid News