Maine
Provider Communications

September 2019 Anthem Maine Provider News

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Title Category

Access requirements for behavioral healthcare services

Behavioral Health

Anthem launches Sydney on September 1; new app offers better digital health care support to members

Administrative

Appointment access standards for primary care, specialty care and behavioral health practitioners

Administrative

Changes to prior authorization requirements effective December 1, 2019

Medicare

Claim editing update for Excludes1 notes

Administrative

Claims requiring additional documentation facility reimbursement policy update

Reimbursement Policies

Clinical criteria updates

Medicare

Clinical criteria updates for specialty pharmacy

Pharmacy

Clinical guideline updates are available on anthem.com

Medical Policy & Clinical Guidelines

Commercial Risk Adjustment (CRA) Reporting Update: Risk Adjustment Data Validation (RADV) Audit happening now

Administrative

Controlling high blood pressure

Administrative

Customizations to the 23rd edition of the MCG Care Guidelines

Medicare

Electronic attachments coming soon

Medicare

Keep up with Medicare news

Medicare

Medical policy updates are available on anthem.com

Medical Policy & Clinical Guidelines

New Clinical Guideline: Pneumatic Compression Devices effective December 1, 2019

Medical Policy & Clinical Guidelines

New Reimbursement Policies - Maternity Services and Multiple Delivery - professional

Reimbursement Policies

New Reimbursement Policy - Intensity Modulated Radiation Therapy Planning and Delivery - professional

Reimbursement Policies

PCP after-hours access requirements

Administrative

Pharmacy benefit manager change to IngenioRx

Medicare

Provider transparency update

Administrative

Reminder: Changes to timely filing requirements coming in October

Administrative

Specialty pharmacy prior authorization list to be expanded effective December 1, 2019

Pharmacy
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