Maine
Provider Communications

Notices of material changes/amendments to contract - December 2022

Case management program

Important information about utilization management

Coordination of care

Member assessment of PCP after-hours messaging in 2022

Member’s assessment of behavioral healthcare after-hours messaging in 2022

Members’ rights and responsibilities

CAA: Timely updates help keep our provider directories current

Clinical practice and preventive health guidelines available on anthem.com

Signature requirements for laboratory orders or requisitions

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

PCP searches in Find Care

Notices of material changes/amendments to contract - November 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:

• Correction to reimbursement policy: Place of Service - Facility
• Medical policy and clinical guideline updates available on anthem.com
• Specialty pharmacy updates - November 2022

Post office boxes being retired because of low usage

Support documentation for AIM prior authorization requests

CAA: Keep your provider directory information up to date

Claims status message enhancements: providing clear descriptions and actionable next steps

Authorization application enhancements: faster, easier, and more efficient

Submit digital attachments within seven calendar days for claims filed with a PWK segment indicator

You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too

Visit the Provider Learning Hub to view our latest learning opportunities

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Important COVID-19 update: Prior authorization and other policy adjustments - RETIRED as of November 8, 2022

As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. 
Future updates regarding COVID-19 will appear in the monthly Provider News publication.

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