Updated 2023 provider manual now available

Anthem Blue Cross and Blue Shield reviews and updates our online provider manual annually. The updated manual is effective August 1, 2023, and is available now on our public provider website at anthem.com. Select Providers and choose Policies, Guidelines and Manuals under Provider Resources in the horizontal menu. Select Missouri as the state if needed and scroll down to the Provider Manual section. Select Download the Manual. Scroll down to Get Your Provider Manual.

Aside from minor formatting changes, content in the following sections (listed in alphabetical order) was updated:

• Appointment Access and Geographic Availability:
  • Added Routine — Regular Appointments under Behavioral Health
• Availity Essentials:*
  • Updated section title and expansion of capability information
• Carelon Medical Benefits Management, Inc.:*
  • Revised section formerly titled AIM Specialty Health_® to current name
• Centers of Medical Excellence:
  • Updated statistics, added medication-assisted treatment (MAT) under Substance Use Treatment and Recovery, and changed Chimeric Antigen Receptor T cell therapies (CAR-T) products from five to six.
• Claim Payment Disputes:
  • Added a list of reasons to submit a claim payment dispute
  • Clarified dispute and appeal along with filing timelines previously shared in the April 2023 Provider Newsletter article, Update to Claim Payment Dispute process
• Claim Submission:
  • Added more information on digital claim submission
• Clinical Data Sharing:
  • Updated information previously shared in March 2023 Provider Newsletter article, New policy for EMR clinical data sharing and ADT notifications
• Clinical Appeals:
  • Submission can be done through Availity Essentials
  • Added submission timeline for returning requested information
  • Added information to be submitted with clinical appeals
• Continuity and Care Coordination:
  • Added Behavioral Health practitioners
• Dispute Resolution, Mediation, and Arbitration:
  • Revised language
• Electronic data interchange (EDI):
  • Added EDI Response Reports
  • Added specific information for corrected claims
• Federal Employees Health Benefits Program:
  • Updated members admitted to a skilled nursing facility to indicate they must be seen by a pulmonologist at least weekly after initial visit (within 12 hours of admission).
• Fraud, Waste, and Abuse Detection:
  • Added pre-payment review under Investigation Process for Special Investigations Unit (SIU)
• Introduction:
  • Revised content for ease of readability
• Medical Record Submission:
  • Additional content digital record submission
  • Timeline for submitting requested records
• Overview of HEDIS^®:
  • Updated information on measures
• Online Provider Directories and Demographic Data Integrity:
  • Updated information on methods of submitting provider data
• Quality Improvement Programs:
  • Updated Program Overview and Goals and Objectives
  • Under Quality and Safety of Clinical Care, removed Chronic Disease and Prevention and added MyHealth Coach
  • Removed Service Quality and revised Patient Safety for Members
• Reimbursement Requirements and Policies:
  • Revised Blood, Blood Products and Administration
  • Updated Changes During Admission to include Continuous Outpatient Encounter
  • Revised Lab Charges
  • Revised Operating Room Time and Procedure Charges section
  • Revised Respiratory Services section
  • Added Services Related to Non-Covered Services, Supplies, or Treatment
• Utilization Management:
  • Revised content in On-Site/Electronic Medical Record Review (EMR) section
  • Revised content in Retrospective Utilization Management section

The 2022 provider manual for Missouri will also be available until August 1, 2023.