New prior authorization requirements for providers may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.


Changes to Prior Authorization Requirements


  • Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020*

  • Updates for specialty pharmacy are available - September 2020*

  • Reimbursement policy update: Distinct Procedural Services - Modifiers 59, XE, XP, XS, XU (Professional)*

  • Reimbursement policy update: Frequency Editing (Professional)*


Featured In:
September 2020 Anthem Provider News - Indiana