Kentucky
Provider Communications

July 2020 Anthem Provider News - Kentucky

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Title Category

Level of care medical necessity reviews for upper and lower endoscopy procedures begin October 1, 2020

Products & Programs

Updated coverage for HIV PrEP medications

Pharmacy

Anthem prior authorization updates for specialty pharmacy are available - July 2020

Pharmacy

Important change to prior authorization requests for inpatient hospital admissions

Administrative

Welcome to the Custom Learning Center in Availity

Administrative

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Program Year Progression - What’s in it for you and your patients?

Administrative

New MCG 24th Edition Guidelines

Medical Policy & Clinical Guidelines

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determination

Medical Policy & Clinical Guidelines

Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members

Federal Employee Plan (FEP)

Submit behavioral health authorizations via our online Interactive Care Reviewer tool

Medicaid

Coding spotlight: Provider’s guide to code social determinants of health

Medicaid

Coding spotlight: Provider’s guide to coding for cardiovascular conditions

Medicaid

Reminder: Mid-level practitioners are required to file using their NPI

Medicaid

Modifier use reminders

Medicaid

Medicare News - July 2020

View these Medicare articles:
- New behavioral health discharge call-in line
- Medical policies and clinical utilization management guidelines update
- Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines
- Transition to AIM rehabilitative services clinical appropriateness guidelines
- Modifier use reminders
Medicare

Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

Medicare

2020 affirmative statement concerning utilization management decisions

Medicare

Medical drug benefit clinical criteria updates

Medicare

In-Office Assessment Program

Medicare

2020 Special Needs Plans

Medicare
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