Maine
Provider Communications

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

Information from Anthem for Care Providers about COVID-19 (updated April 15, 2022)

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

Clinical criteria updates

Annual wellness visits for Medicare Advantage members

Medication adherence

Keep up with Medicare news

• Medical step therapy updates
• Phone number change for AIM in Maine

New! Vaccination resource page for providers

Updated preventive care guidance regarding screening colonoscopies

Understanding your patients’ differences is lifesaving

Your influence matters: Recommending cancer screenings to your patients

Simplifying requests for additional information

HEDIS 2022 Federal Employee Program® medical record request requirements

GN, GO, GP therapy modifier requirement paused for Anthem Maine members

Provider Manual to be updated April 4, 2022

Notices of material changes/amendments to contract

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:

• Specialty pharmacy updates - February 2022
• Clinical criteria updates for specialty pharmacy

Specialty pharmacy updates - February 2022

Clinical criteria updates for specialty pharmacy

Get faster payments with EFT

Prepare for the CAA: Keep your provider directory information current

Cancer Care Navigator

It is CAHPS survey time!

Heart disease is the number one killer of women

Pharmacy information available on anthem.com

Important COVID-19 update: Prior authorization and other policy adjustments (updated January 18, 2021)

New Medicare Advantage plan will have access to Blue Cross Blue Shield Medicare Advantage PPO Network Sharing providers nationally

Notices of material changes/amendments to contract

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:

• Medical policy and clinical guideline updates

Well-child visits: Know the numbers

Medical policy and clinical guideline updates

BlueHPN network live in Maine for 2022

2022 FEP® benefit information available online

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Professional claims - billing referring provider and NPI for home infusion therapy and ambulatory infusion suite

Important update on Botox® for Medicare members of AMH Health, LLC

Keep up with Medicare news

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update
• Medical step therapy updates
• AMH Health, LLC expands specialty pharmacy precertification list

Anthem is transitioning to the Availity Authorization App

Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date

Blue Precision program to be retired on December 31, 2021

IMPORTANT: Taxonomy codes for APRNs, mid-wives, physician assistants, and behavioral health facilities billing on CMS-1500 form

Important information about utilization management

Submitting prior authorizations is getting easier

Is prior authorization required?

RETRACTION: Inpatient Facility Transfers - facility reimbursement policy

Behavioral healthcare appointment access requirements

Drug Screen Testing policy update - effective March 1, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

2022 Medicare Advantage service area and benefit updates

Somatus is your resource for kidney care management

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

Good news: Non-payment remittance advice enhancements are here

Keep up with Medicare news

• Updates to AIM Specialty Health musculoskeletal interventional pain management
  clinical appropriateness guideline
• Medical drug benefit clinical criteria updates
• Protocol for providers serving members with hearing aid coverage administered by Hearing Care Solutions
• Medical Policies and Clinical Utilization Management Guidelines update

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline

Clinical criteria updates for specialty pharmacy