Maine
Provider Communications

Register for our upcoming CME webinar about low back pain management

Notices of material changes/amendments to contract - October 2022

• Precertification list changes effective January 1, 2023
• Clinical Criteria updates for specialty pharmacy
• Specialty pharmacy updates - October 2022
• Reimbursement policy update: Multiple and Bilateral Surgery Processing – Professional

Monkeypox and smallpox vaccines: Product code on claims

Precertification list changes effective January 1, 2023

National Accounts 2023 Pre-certification list

CAA: Review your online provider directory information

Prior authorization required for hip and knee services for State of Maine Health Plan members effective July 1, 2022

Provider Learning Hub is here

IngenioRx will become CarelonRx on January 1, 2023

Clinical Criteria updates for specialty pharmacy

Specialty pharmacy updates - October 2022

Pharmacy information available on provider website

Reimbursement policy update: Three-Dimensional (3D) Radiology Services - Professional and Facility

Reimbursement policy update: Multiple and Bilateral Surgery Processing - Professional

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

Monkeypox and smallpox vaccines: Product code on claims

Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing - Professional

Courtesy notification of specialty pharmacy medical step therapy updates

Keep up with Medicare news

• Medicare Part B Precert Expansion Alymsys
• Medicare Part B Precert Expansion Amvuttra Xipere
• Consultation Codes

Continuing to Explore the Intersection of Race and Disability

Notices of material changes/amendments to contract - September 2022

Notices of material changes/amendments to contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements. In this issue, please reference the following articles:

• Reimbursement policy update:  Modifier Rules – Professional
• Specialty pharmacy updates - September 2022
• Clinical criteria updates for specialty pharmacy

Anthem to accept Hospital in Home services

Monkeypox resources and recommendations for our care providers

Reimbursement policy update: Modifier Rules - Professional

Reimbursement policy update: Modifier 66: Surgical Teams - Professional

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - Professional

Specialty pharmacy updates - September 2022

Clinical criteria updates for specialty pharmacy

OBRA 93 claim filing for Federal Employee Program

Enhancing claims attachment processes through digital applications

Prior authorization requirement changes effective December 1, 2022

Reimbursement policy update - Modifiers 25 and 57: Evaluation and Management with Global Procedures (Policy G- 06003)

AMH Health LLC. expands specialty pharmacy precertification list

AMH Health, LLC expands specialty pharmacy precertification list

Keep up with Medicare news    

• Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ
• Clinical Criteria updates

Continuing to Explore the Intersection of Race and Disability

Important information about women’s preventive care visits

Drug code billing reminder

CAA: Current provider directory information is key for members and providers to engage with you seamlessly

Updates to the Claim Attachment workflow

Update to formulary lists for Commercial health plan pharmacy benefit

New Back Pain Management Program

Information from Anthem for Care Providers about COVID-19 (updated August 8, 2022)

Specialty pharmacy updates

Clinical criteria updates for specialty pharmacy

Notices of material changes/amendments to contract - August 2022

Notices of material changes/amendments to contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements. In this issue, please reference the following articles:

• Reimbursement policy update: Place of Service - Facility
• Medical policy and clinical guideline updates are available on anthem.com
• Specialty pharmacy updates
• Clinical criteria updates for specialty pharmacy

Performance enhancements to the authorization application on Availity Essentials

Reimbursement policy update: Place of Service - Facility

Medical policy and clinical guideline updates are available on anthem.com

Pharmacy information available on anthem.com

Reminder: Inpatient/outpatient commercial claim denials

Timely updates help keep our provider directories current

Introducing the Provider Learning Hub

Add supporting documents directly to your claims with the new Claims Status Inquiry Send Attachments feature

Telehealth visits can impact after-hospitalization follow-up care for mental illness

Join us for our next clinical quality in practice webinar

Introducing Elevance Health — Focusing on whole health and its most powerful drivers

Notices of material changes/amendments to contract - July 2022

Notices of material changes/amendments to contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements. In this issue, please reference the following articles:

• Clinical criteria updates for specialty pharmacy

Enhanced reimbursement for voluntary Cancer Care Quality Program to be discontinued effective December 31, 2022

Update to facility editing: HCPCS code G0463

Help patients heal from the comfort of home with Hospital in Home care

More potato chips, sugary drinks, and less physical activity are key contributors to childhood obesity

Clearing up coding confusion for diabetic retinal screenings

CAA: Keep your provider directory information current

Enhancing claims attachment processes through digital applications: Add attachments through Claims Status Inquiry

Coming soon: Anthem Provider Learning Hub makes Availity learning easier

New reimbursement policy: Transitional Care Management - Professional

Retraction for reimbursement policy - Sexually Transmitted Infections – Professional

Clinical criteria updates for specialty pharmacy

Pharmacy information available online

Prior authorization required for hip and knee services for State of Maine Health Plan members effective July 1, 2022

Cancer Care Navigator

MCG care guidelines 26th edition

Keep up with Medicare news

Prior authorization required for hip and knee services for State of Maine Health Plan members effective July 1, 2022

Introducing Elevance Health — Focusing on whole health and its most powerful drivers

Exploring the Intersection of Race and Disability

Notices of material changes/amendments to contract - June 2022

Exploring the Intersection of Race and Disability forum

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services (facility)

Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines

Updated AIM Musculoskeletal Program effective October 1, 2022

Specialty pharmacy updates - June 2022

Medical policies and clinical utilization management guidelines update

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

Medical drug benefit clinical criteria updates

Evaluation and management services for COVID testing - professional

Keep up with Medicare news

• Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines
• New specialty pharmacy medical step therapy requirements
• AMH Health, LLC. expands specialty pharmacy precertification list
• Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines

Provider outreach to validate your provider data

Once-a-year testing is critically important to providing quality diabetes care

CAA: Provider directories accuracy is important

Opioid overdose deaths: What can we do?

Process change for Federal Employee Program® third-party correspondence requests

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Notices of material changes/amendments to contract - May 2022

Notices of material changes/amendments to contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements. In this issue, please reference the following articles:

• Provider Manual updated effective July 1, 2022
• Medical policy and clinical guideline updates available on anthem.com
• Clinical criteria updates for specialty pharmacy
• Specialty pharmacy updates - May 2022

Provider Manual updated effective July 1, 2022

Primary care appointment access and open panels