Anthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageAugust 1, 2024

August 2024 Provider Newsletter

Featured Articles

Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

MCG Care Guidelines 28th edition

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

Notices of material changes/amendments to contract — August 2024


Administrative

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

CAA: Providers required to verify their online provider directory information

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Incidental services — facility editing update

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Device-dependent procedures — facility editing update

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageAugust 1, 2024

ICD-10-CM Excludes1 notes

Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialJuly 24, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 16, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Coming soon: View your fee schedule in Availity Essentials Payer Spaces

Digital SolutionsAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 9, 2024

Coming soon — digital-only authorization case status notifications for Medicare

Education & Training

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageAugust 1, 2024

Coming soon: Provider e-Learning Resource Center for Payment Integrity

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageAugust 1, 2024

August is National Breastfeeding Month

Policy Updates

Policy UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJuly 10, 2024

Clinical Criteria updates

Effective August 12, 2024

Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

Medical Policy and Clinical Guideline updates

Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Medical Policy & Clinical GuidelinesAMH Health, LLC | Medicare AdvantageJuly 15, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 19, 2024

Medical Policy & Clinical GuidelinesAMH Health, LLC | Medicare AdvantageJuly 17, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 11, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after November 17, 2024

Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialJuly 2, 2024

Notice of material change/amendment to contract

Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines

Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notification of authorization fax number changes

Reimbursement PoliciesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

New reimbursement policy: Intraoperative Neuromonitoring — Professional

Reimbursement PoliciesAMH Health, LLC | Medicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

Reimbursement PoliciesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

Reimbursement policy update: Professional Anesthesia Service

Reimbursement PoliciesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

Reimbursement policy update: Bundled Services and Supplies — Facility

Reimbursement PoliciesAMH Health, LLC | Medicare AdvantageAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

PharmacyAnthem Blue Cross and Blue Shield | CommercialJuly 25, 2024

Notice of material change/amendment to contract

Specialty pharmacy updates — February 2024

Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.

PharmacyAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

Specialty pharmacy updates — August 2024

Tevimbra, Tyenne, and Wezlana

PharmacyAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notice of material change/amendment to contract

Clinical Criteria updates for specialty pharmacy

MEBCBS-CRCM-063094-24