Notice of Changes to Prior Authorization Requirements - December 2018

New Prior Authorization Requirements for providers and 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 and Clinical Guidelines Updates – December 2018

• Reimbursement Policy Updates - December 2018

• GM Precertification and Integrated Health Management (360 Health) changes for CY 2019

• Anthem Accepts Electronic Prior Authorization Requests for Prescription Medications Online

Other Important Updates

 

• Upcoming changes for automotive accounts

 

• Anthem to Enhance Claim Edits for Outpatient Facility Claims

 

• Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

 

• Update to AIM Clinical Appropriateness Guidelines

 

• Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

 

• Bundled Services and Supplies (Professional)

• Information about our Case Management and Condition Care Programs, Coordination of Care, Integrated Care Model, Utilization Management, Quality Improvement and Members Rights & Responsibilities

• Medicare Advantage and Medicaid Updates