Notice of Changes to Prior Authorization Requirements - January 2021

New prior authorization requirements for providers may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements and are starred (*) below.

• Designated specialty pharmacy network*
• Prior authorization updates for specialty pharmacy are available – January 2021*
• Medical Policy and Clinical Guideline Updates – January 2021*
• MCG Care Guidelines 24th Edition Customization*
• Reimbursement policy update: Multiple diagnostic imaging procedures – Professional*
• Reimbursement policy update: Frequency Editing – Professional*
• Reimbursement policy update: Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation – Professional*
• Reimbursement policy update: Modifier Rules – Professional*
• Reimbursement policy update: Unit Frequency Maximum for Drugs and Biologicals – Professional*

Other important updates:

• Evaluation and management changes 2021
• Anthem implements pilot program for in-network skilled nursing facilities (SNF)