CommercialMarch 1, 2021

March 2021 Anthem Provider News - Indiana

Administrative

AdministrativeCommercialMarch 1, 2021

Notice of Changes to Prior Authorization Requirements - March 2021
New prior authorization requirements for providers may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

AdministrativeCommercialMarch 1, 2021

Medical attachment capability now includes itemized bills and more!

Policy Updates

Medical Policy & Clinical GuidelinesCommercialMarch 1, 2021

Anthem clarifies guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)

Medical Policy & Clinical GuidelinesCommercialMarch 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery guideline

Reimbursement PoliciesCommercialMarch 1, 2021

New reimbursement policy update: Place of Service Evaluation and Management - Facility*
*Change to Prior Authorization Requirements

Reimbursement PoliciesCommercialMarch 1, 2021

Claims editing update for ICD-10-CM Excludes 1 notes

Products & Programs

PharmacyCommercialMarch 1, 2021

Some HIV medication combinations may require prior authorization*
*Change to Prior Authorization Requirements

PharmacyCommercialMarch 1, 2021

Updates for specialty pharmacy are available - March 2021*
*Change to Prior Authorization Requirements

PharmacyCommercialMarch 1, 2021

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021*
*Change to Prior Authorization Requirements

State & Federal

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

Availity Portal eligibility and benefits provides both additional benefit notes and digital member ID cards

State & FederalMedicare AdvantageMarch 1, 2021

Digital transactions cut administrative tasks in half

State & FederalMedicare AdvantageMarch 1, 2021

Medical policies and clinical utilization management guidelines update

State & FederalMedicare AdvantageMarch 1, 2021

New provider directory indicator for telehealth services

State & FederalMedicare AdvantageMarch 1, 2021

Medicare News - March 2021
View these Medicare articles:
- MCG Care Guidelines 24th edition customization
- DME checklist of information needed from providers

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

HEDIS Measurement Year 2020: Medicaid summary of changes from NCQA

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

CAHPS® survey

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

Disease Management/Population Health program

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

Prior authorization requirements for HCPCS code 55899

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

Neulasta medical step therapy requirements

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

Digital transactions cut administrative tasks in half

State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 1, 2021

New Hoosier Care Connect contract starting April 2021