Maine
Provider Communications

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

Medical policy and clinical guideline updates available on anthem.com

Clinical criteria updates for specialty pharmacy

Specialty pharmacy updates - May 2022

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

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

Keep up with Medicare news

• AMH Health, LLC expands specialty pharmacy precertification list
• AMH Health, LLC expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements

Anthem announces changes to post-payment audits conducted on our behalf

May is National High Blood Pressure Education Month: We’ve got this!

Alcohol use disorder has a big cost

Resources to support diverse patients and communities

Coding tips for reporting administration of Spravato®

CAA: Timely updates help keep our provider directories current

Join us for an FEP Quality Learning Program live webinar

HEDIS 2022: summary of changes from NCQA

New specialty pharmacy medical step therapy requirements

Improving antibiotic use for acute respiratory infections in the outpatient setting

The Anthem, Inc. name is changing

HEDIS 2022: Summary of changes from NCQA

Catching up on routine vaccines

Reminder on Botox® for Anthem members

CAA: Update your provider directory information

Procedure searches in Find Care

Pharmacy information available on anthem.com

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

Notices of material changes/amendments to contract – April 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 article:

• Specialty pharmacy updates - April 2022

Specialty pharmacy updates - April 2022

Model of Care required training

Clinical criteria updates

Update - Inpatient Readmissions Policy G-13001 effective July 1, 2022

The impact of listening

Keep up with Medicare news

• Medical Policies and Clinical Utilization Management Guidelines update
• AMH Health, LLC expands specialty pharmacy precertification list
• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

The Anthem, Inc. name is changing

Exploring Implicit Bias in Healthcare for Historically Marginalized Communities

Notices of material changes/amendments to contract – March 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:

• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates
• Clinical criteria updates for specialty pharmacy
• Correction to February 2022 specialty pharmacy updates
• Specialty pharmacy updates - March 2022

Consolidated Appropriations Act (CAA): Have you reviewed your online provider directory information lately?

Enhancements to the Availity Authorization application are now available

AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates

Clinical criteria updates for specialty pharmacy

Correction to February 2022 specialty pharmacy updates

Specialty pharmacy updates - March 2022

New address for Federal Employee Program® clinical grievances and appeals

Prior authorization requirement change effective June 1, 2022