Notice of Changes to Prior Authorization Requirements -- August 2019

Changes to Prior Authorization Requirements

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.

Medical Policies and Clinical Guidelines

• Medical Policy and Clinical Guideline Updates -- August 2019*
• Anthem customizations to MCG care guidelines 23rd edition*
• Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

Reimbursement Policies

• Reimbursement Policy Update: Bundled Services-Professional*
• Reimbursement Policy Update: Frequency Editing-Professional*
  
  

Pharmacy Updates

• Clinical criteria and prior authorization updates for specialty pharmacy are available*
• REMINDER: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019
  
  

Other Important Updates

• Medicare and Medicaid News