CommercialDecember 30, 2022

January 2023 Anthem Provider News - Indiana

Administrative

AdministrativeCommercialDecember 30, 2022

Professional system updates for 2023

AdministrativeCommercialMedicare AdvantageDecember 30, 2022

Notification regarding reimbursement changes to COVID-19 laboratory services codes

AdministrativeCommercialDecember 30, 2022

Outpatient system updates for 2023

AdministrativeCommercialMedicare AdvantageDecember 30, 2022

Childhood Immunization Status and Lead Screening in Children for HEDIS

Policy Updates

Medical Policy & Clinical GuidelinesCommercialDecember 30, 2022

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update*
*Change to Prior Authorization Requirements

Medical Policy & Clinical GuidelinesCommercialDecember 30, 2022

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines*
*Change to Prior Authorization Requirements

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 30, 2022

Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines*
*Change to Prior Authorization Requirements

Medical Policy & Clinical GuidelinesCommercialDecember 30, 2022

Change to Prior Authorization Requirements

Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 30, 2022

Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines*
*Change to Prior Authorization Requirements

Reimbursement PoliciesCommercialDecember 30, 2022

Outpatient facility revenue code billing requirements

Products & Programs

Federal Employee Program (FEP)CommercialDecember 30, 2022

Federal Employee Program observation conversion for musculoskeletal cases*
*Change to Prior Authorization Requirements

PharmacyCommercialDecember 30, 2022

Specialty pharmacy updates - January 2023*
*Change to Prior Authorization Requirements

State & Federal

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingDecember 30, 2022

Guidance for coding evaluation and management services for new and established patients

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingDecember 30, 2022

Attention physicians and lab providers: COVID-19 update regarding reimbursement

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingDecember 30, 2022

Keep up with Medicaid News - January 2023
- This is Quitting: Helping teens and young adults quit vaping
- Prior Authorization Updates for Medications Billed Under the Medical Benefit (Vabysmo)

State & FederalMedicare AdvantageDecember 30, 2022

Cleveland-Cliffs offers Medicare Advantage option

State & FederalMedicare AdvantageDecember 30, 2022

Keep up with Medicare news - January 2023
- Prior authorization requirement changes
- New specialty pharmacy medical step therapy requirements (Inflectra & Renflexis)
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Cimerli)
- Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines