Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 12, 2024
Lab testing reminder
Background
Anthem follows MCG Care Guidelines for the following lab tests.
You can view appropriate Clinical Utilization Management Guidelines (CUMGs) here.
Update
In compliance with MCG Care Guidelines, only medically necessary lab testing will be covered. Effective March 1, 2024, coverage for these labs will be denied unless medically necessary:
Clinical UM Guideline number/title | Clinical indications for medical necessity |
GGT testing using blood is considered medically necessary for any of the following indications:
|
MCD ENT — CG‑Lab‑30: Outpatient Laboratory-based Blood Glucose Testing | Medically necessary Blood glucose testing is considered medically necessary for individuals who meet any of the following criteria (A through Q):
1. Up to once yearly for individuals with prediabetes; or 2. Up to two times per year for individuals with diabetes mellitus who are meeting treatment goals; or 3. Within the first year postpartum and then up to once yearly for individuals who have had gestational diabetes.
Notes: |
What if I have questions?
Availity Chat with Payer is available during normal business hours. Get answers to your questions about eligibility, benefits, authorizations, claims status, and more. To access Availity Essentials, go to Availity.com and select the appropriate payer space tile from the drop-down. Then, select Chat with Payer and complete the pre-chat form to start your chat.
For additional support, visit the Contact Us section at the bottom of our provider website.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.
INBCBS-CD-048162-23-CPN47422
PUBLICATIONS: March 2024 Provider Newsletter
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Visit https://providernews.anthem.com/indiana/articles/lab-testing-reminder-18204-18204
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