Kentucky
Provider Communications

Articles Category: State & Federal

Title Publication Category Date

Keep up with Medicaid News - March 2023

- Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List update
Medical Policies and Clinical Utilization Management Guidelines update
Clinical Criteria updates
- Prior authorization updates for medications billed under the medical benefit (Carvykti)
- Prior authorization updates for medications billed under the medical benefit (Aduhelm)
March 2023 Anthem Provider News - Kentucky Medicaid Mar 1, 2023

Keep up with Medicare News - March 2023

- Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List in Kentucky
- Carelon Medical Benefits Management, Inc. Genetic Testing Clinical Appropriateness Guidelines CPT code list update
- What date to select for inpatient admissions for claims
- Clinical Criteria updates
- New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)
- Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines
March 2023 Anthem Provider News - Kentucky Medicare Mar 1, 2023

Annual planned visits

March 2023 Anthem Provider News - Kentucky Medicare Mar 1, 2023

Controlling High Blood Pressure and Submitting Compliant Readings

March 2023 Anthem Provider News - Kentucky Medicare Mar 1, 2023

Shared savings and transition care management after inpatient discharges

March 2023 Anthem Provider News - Kentucky Medicare Mar 1, 2023

Informational Update Modifier Usage

March 2023 Anthem Provider News - Kentucky Medicare Mar 1, 2023

Monkeypox and smallpox vaccines: Product code on claims

February 2023 Anthem Provider News - Kentucky Medicaid Feb 1, 2023

Childhood Immunization Status and Lead Screening in Children for HEDIS

February 2023 Anthem Provider News - Kentucky Medicaid Feb 1, 2023

Keep up with Medicaid News - February 2023

- Clinical Criteria updates
- This is Quitting: Helping teens and young adults quit vaping
- Billing for sports physical exams
- Prior authorization updates for medications billed under the medical benefit (Enjaymo, Kimmtrak, Tezspire, Voxzogo)
- Prior authorization updates for medications billed under the medical benefit (Releuko, Vabysmo)
- Introducing the Provider Learning Hub
February 2023 Anthem Provider News - Kentucky Medicaid Feb 1, 2023

Keep up with Medicare News - February 2023

- Introducing the Provider Learning Hub
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Fylnetra)
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Spevigo, Xenpozyme)
- Specialty pharmacy precertification list expansion (Rolvedon, Stimufend)
- New specialty pharmacy medical step therapy requirements
- Prior authorization requirement changes effective April 1, 2023
- Medical Policies and Clinical Utilization Management Guidelines update
February 2023 Anthem Provider News - Kentucky Medicare Feb 1, 2023

Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023

February 2023 Anthem Provider News - Kentucky Medicare Feb 1, 2023

2023 FEP benefit information available online

February 2023 Anthem Provider News - Kentucky Federal Employee Plan (FEP) Feb 1, 2023

Standing Orders for Administering Human Papillomavirus Vaccine to Children and Teens

January 2023 Anthem Provider News - Kentucky Medicaid Dec 30, 2022

10 Steps to Implementing Standing Orders for Immunization in Your Practice Setting

January 2023 Anthem Provider News - Kentucky Medicaid Dec 30, 2022

Using Standing Orders for Administering Vaccines: What You Should Know

January 2023 Anthem Provider News - Kentucky Medicaid Dec 30, 2022

HPV Vaccination Starts at 9: Provider and Health Systems Toolbox

January 2023 Anthem Provider News - Kentucky Medicaid Dec 30, 2022

HPV Vaccine Provider Incentive Program ages 9 to 13

January 2023 Anthem Provider News - Kentucky Medicaid Dec 30, 2022

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

January 2023 Anthem Provider News - Kentucky Medicaid Dec 30, 2022

Keep up with Medicaid News - January 2023

- Medical drug benefit Clinical Criteria updates
January 2023 Anthem Provider News - Kentucky Medicaid Dec 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
January 2023 Anthem Provider News - Kentucky Medicare Dec 30, 2022

Cleveland-Cliffs offers Medicare Advantage option

January 2023 Anthem Provider News - Kentucky Medicare Dec 30, 2022

Federal Employee Program observation conversion for musculoskeletal cases

January 2023 Anthem Provider News - Kentucky Federal Employee Plan (FEP) Dec 30, 2022

Keep up with Medicaid News - December 2022

- Prior authorization updates for medications billed under the medical benefit (Fyarro, BESREMi, Vyvgart, Adbry, Leqvio)
- New specialty pharmacy medical step therapy requirements (Mvasi, Avastin, Zirabev)
December 2022 Anthem Provider News - Kentucky Medicaid Dec 1, 2022

Monkeypox resources and recommendations for our care providers

December 2022 Anthem Provider News - Kentucky Medicaid Dec 1, 2022

Important information about utilization management

December 2022 Anthem Provider News - Kentucky Medicaid Dec 1, 2022

Keep up with Medicare News - December 2022

- Medical drug benefit Clinical Criteria updates
- Medical Policies and Clinical Utilization Management Guidelines update
December 2022 Anthem Provider News - Kentucky Medicare Dec 1, 2022

2023 Medicare Advantage service area and benefit updates

December 2022 Anthem Provider News - Kentucky Medicare Dec 1, 2022

Personal home helper benefit ending

December 2022 Anthem Provider News - Kentucky Medicare Dec 1, 2022

Keep up with Medicaid News - November 2022

- Prior authorization requirement changes effective November 1, 2022
- Provider notice for COVID-19 testing
- New phone number for AIM Specialty Health
- Prior authorization requirement changes
- Mental health needs during the eastern Kentucky flood
- New specialty pharmacy medical step therapy requirements
November 2022 Anthem Provider News - Kentucky Medicaid Nov 1, 2022

Personalized Match

November 2022 Anthem Provider News - Kentucky Medicare Nov 1, 2022

Enhancing claims attachment processes through digital applications

November 2022 Anthem Provider News - Kentucky Medicaid Nov 1, 2022

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing - Professional

November 2022 Anthem Provider News - Kentucky Medicaid Nov 1, 2022

Alcohol use disorders often coexist with psychiatric disorders

November 2022 Anthem Provider News - Kentucky Medicaid Nov 1, 2022

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

November 2022 Anthem Provider News - Kentucky Medicaid Nov 1, 2022

Keep up with Medicare News - November 2022

- Medical drug benefit Clinical Criteria updates
- New specialty pharmacy medical step therapy requirements (Avastin, Mvasi)
- New specialty pharmacy medical step therapy requirements (Zarxio)
- Provider notice for COVID-19 testing
November 2022 Anthem Provider News - Kentucky Medicare Nov 1, 2022

Enhancing claims attachment processes through digital applications

November 2022 Anthem Provider News - Kentucky Medicare Nov 1, 2022

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

November 2022 Anthem Provider News - Kentucky Medicare Nov 1, 2022

Availity Essentials provider chat - a fast, easy way to get your UM questions answered for Federal Employee members

October 2022 Anthem Provider News - Kentucky Federal Employee Plan (FEP) Oct 1, 2022

Keep up with Medicare News - October 2022

  • Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ
  • Anthem expands specialty pharmacy precertification list-1
  • Anthem expands specialty pharmacy precertification list-2
  • Consultation codes
October 2022 Anthem Provider News - Kentucky Medicare Oct 1, 2022

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing - Professional

October 2022 Anthem Provider News - Kentucky Medicare Oct 1, 2022

Courtesy notification of specialty pharmacy medical step therapy updates

October 2022 Anthem Provider News - Kentucky Medicare Oct 1, 2022

Keep up with Medicaid News - October 2022

  • Prior authorization update for select durable medical equipment (DME) items
  • Prior authorization updates for medications billed under the medical benefit-1
  • Prior authorization updates for medications billed under the medical benefit-2
  • HPV Vaccine Provider Incentive program for members aged 13
October 2022 Anthem Provider News - Kentucky Medicaid Oct 1, 2022

Medical drug benefit Clinical Criteria updates

October 2022 Anthem Provider News - Kentucky Medicaid Oct 1, 2022

New Digital Provider Enrollment tool added to Availity

October 2022 Anthem Provider News - Kentucky Medicaid Oct 1, 2022

Clinical Criteria updates

October 2022 Anthem Provider News - Kentucky Medicaid Oct 1, 2022

Members’ Rights and Responsibilities section

October 2022 Anthem Provider News - Kentucky Medicaid Oct 1, 2022

Updates for medication codes billed under the medical benefit

October 2022 Anthem Provider News - Kentucky Medicaid Oct 1, 2022

New Digital Provider Enrollment tool added to Availity

October 2022 Anthem Provider News - Kentucky Medicare Oct 1, 2022

OBRA 93 claim filing for Federal Employee Program

September 2022 Anthem Provider News - Kentucky Federal Employee Plan (FEP) Sep 1, 2022

Anthem Medicaid responds to those affected by floods in eastern Kentucky

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

Keep up with Medicaid News - September 2022

- New Strategic Provider System will launch in August 2022
- Clinical criteria updates
- COVID-19 Vaccine Provider Incentive Program ages 6 months+
- Prior authorization updates for medications billed under the medical benefit
September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

Specialty pharmacy site of care program retraction

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

Complex Case Management program

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

New reimbursement policy: Diagnosis-related group newborn inpatient stays - Facility

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

New specialty pharmacy medical step therapy requirements

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

Alcohol use disorders linked to chronic diseases

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

InterQual 2022 revisions

September 2022 Anthem Provider News - Kentucky Medicaid Sep 1, 2022

Keep up with Medicare News - September 2022

- Anthem expands specialty pharmacy precertification list
- Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ
- New Strategic Provider System will launch in August 2022
September 2022 Anthem Provider News - Kentucky Medicare Sep 1, 2022

Reminder: AIM prior authorization phone number change for Medicare

September 2022 Anthem Provider News - Kentucky Medicare Sep 1, 2022

Prior authorization requirement changes effective December 1, 2022

September 2022 Anthem Provider News - Kentucky Medicare Sep 1, 2022

Anthem expands specialty pharmacy precertification list

September 2022 Anthem Provider News - Kentucky Medicare Sep 1, 2022

Reimbursement policy update: Modifiers 25 and 57 - Evaluation and Management with Global Procedures

September 2022 Anthem Provider News - Kentucky Medicare Sep 1, 2022

Keep up with Medicaid News - August 2022

- Medical drug benefit Clinical Criteria updates
August 2022 Anthem Provider News - Kentucky Medicaid Aug 1, 2022

Prior authorization requirement changes effective November 1, 2022

August 2022 Anthem Provider News - Kentucky Medicaid Aug 1, 2022

Chlamydia screening

August 2022 Anthem Provider News - Kentucky Medicaid Aug 1, 2022

Using SBIRT to address opioid and substance use disorders

August 2022 Anthem Provider News - Kentucky Medicaid Aug 1, 2022

The cost of alcohol use disorder

August 2022 Anthem Provider News - Kentucky Medicaid Aug 1, 2022

Keep up with Medicare News - July 2022

- New specialty pharmacy medical step therapy requirements
July 2022 Anthem Provider News - Kentucky Medicare Jul 1, 2022

Update use of Modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services

July 2022 Anthem Provider News - Kentucky Medicare Jul 1, 2022

Cancer Care Navigator

July 2022 Anthem Provider News - Kentucky Medicare Jul 1, 2022

Keep up with Medicaid News - July 2022

- Prior authorization updates for medications billed under the medical benefit
July 2022 Anthem Provider News - Kentucky Medicaid Jul 1, 2022

Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines

July 2022 Anthem Provider News - Kentucky Medicaid Jul 1, 2022

Diabetes self-management education and support

July 2022 Anthem Provider News - Kentucky Medicaid Jul 1, 2022

Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines

July 2022 Anthem Provider News - Kentucky Medicare Jul 1, 2022

Authorizations for post-acute care services for Medicare Advantage individual, Group Retiree Solutions (GRS), and Dual-Eligible Plan members

June 2022 Anthem Provider News - Kentucky Medicare Jun 1, 2022

Process change for Federal Employee Program third-party correspondence requests

June 2022 Anthem Provider News - Kentucky Federal Employee Plan (FEP) Jun 1, 2022

Reimbursement policy update: Inpatient Readmissions

June 2022 Anthem Provider News - Kentucky Medicaid Jun 1, 2022

Keep up with Medicare News - June 2022

June 2022 Anthem Provider News - Kentucky Medicare Jun 1, 2022

Evaluation and management services for COVID testing - professional

June 2022 Anthem Provider News - Kentucky Medicare Jun 1, 2022

Medical drug benefit clinical criteria updates

June 2022 Anthem Provider News - Kentucky Medicare Jun 1, 2022

Medical policies and clinical utilization management guidelines update

June 2022 Anthem Provider News - Kentucky Medicare Jun 1, 2022

Keep up with Medicaid News - May 2022

- Medical drug benefit Clinical Criteria updates-March 2022 updates
- COVID-19 Vaccine Provider Incentive program ages 5+
May 2022 Anthem Provider News - Kentucky Medicaid May 1, 2022

Provider Pathways eLearning is here!

May 2022 Anthem Provider News - Kentucky Medicaid May 1, 2022

Reimbursement policy update: Corrected Claims

May 2022 Anthem Provider News - Kentucky Medicaid May 1, 2022

Screening for alcohol use disorder in high-prevalence demographics

May 2022 Anthem Provider News - Kentucky Medicaid May 1, 2022

Keep up with Medicare News - May 2022

- Anthem expands specialty pharmacy precertification list-March 2022 update
- Anthem expands specialty pharmacy precertification list-April 2022 update
- New specialty pharmacy medical step therapy requirements-May 2022 update
May 2022 Anthem Provider News - Kentucky Medicare May 1, 2022

Convenient, reliable at-home testing for colorectal cancer and diabetes care

May 2022 Anthem Provider News - Kentucky Medicare May 1, 2022

HEDIS 2022: summary of changes from NCQA

May 2022 Anthem Provider News - Kentucky Medicare May 1, 2022

New specialty pharmacy medical step therapy requirements-March 2022 update

May 2022 Anthem Provider News - Kentucky Medicare May 1, 2022

CORRECTION: Save time tomorrow by using CPT II codes today: Introducing the FEP Quality Reimbursement Program for PPO providers

May 2022 Anthem Provider News - Kentucky Federal Employee Plan (FEP) May 1, 2022

Join us for an FEP Quality Learning Program live webinar

May 2022 Anthem Provider News - Kentucky Federal Employee Plan (FEP) May 1, 2022

The Anthem, Inc. name is changing

April 2022 Anthem Provider News - Kentucky Medicaid Apr 1, 2022

Keep up with Medicaid News - April 2022

- Botox update for Anthem Medicaid members
- Prior authorization required for specialty pharmacy drugs
- New specialty pharmacy medical step therapy requirements
April 2022 Anthem Provider News - Kentucky Medicaid Apr 1, 2022

Get faster payments with EFT

April 2022 Anthem Provider News - Kentucky Medicaid Apr 1, 2022

Cancer Care Navigator

April 2022 Anthem Provider News - Kentucky Medicaid Apr 1, 2022

Disease Management/Population Health program

April 2022 Anthem Provider News - Kentucky Medicaid Apr 1, 2022

Getting tobacco users the help they need to quit

April 2022 Anthem Provider News - Kentucky Medicaid Apr 1, 2022

The Anthem, Inc. name is changing

April 2022 Anthem Provider News - Kentucky Medicare Apr 1, 2022

Keep up with Medicare News - April 2022

- Medical Policies and Clinical Utilization Management Guidelines update
- AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates
- Anthem expands specialty pharmacy precertification list
April 2022 Anthem Provider News - Kentucky Medicare Apr 1, 2022

Get faster payments with EFT

April 2022 Anthem Provider News - Kentucky Medicare Apr 1, 2022
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