November 1, 2020

November 2020 Anthem Provider News and Important Updates -- Nevada

Administrative

AdministrativeCommercialOctober 31, 2020

Digital transactions cut administrative tasks in half

AdministrativeCommercialOctober 31, 2020

Non-participating lab referrals

Policy Updates

Medical Policy & Clinical GuidelinesCommercialOctober 31, 2020

Medical Policy and Clinical UM Guidelines notification letter (MAC)
Material Adverse Change (MAC)

Medical Policy & Clinical GuidelinesCommercialOctober 31, 2020

REMINDER: Post-service reviews using AIM

Reimbursement PoliciesCommercialOctober 31, 2020

Documentation Standards for Episodes of Care (Professional Reimbursement Policy) -- New (MAC)
Material Adverse Change (MAC)

Reimbursement PoliciesCommercialOctober 31, 2020

Modifier Rules (Professional Reimbursement Policy) -- Update (MAC)
Material Adverse Change (MAC)

Reimbursement PoliciesCommercialOctober 31, 2020

Bundled Services and Supplies (Professional Reimbursement Policy) – Update (MAC)
Material Adverse Change (MAC)

Reimbursement PoliciesCommercialOctober 31, 2020

Claims editing update for ICD-10-CM Excludes 1 notes

Products & Programs

PharmacyCommercialOctober 31, 2020

Anthem prior authorization updates for specialty pharmacy are available (MAC)
Material Adverse Change (MAC)

PharmacyCommercialOctober 31, 2020

IngenioRx Introduces New Pharmacy Network in 2021

PharmacyCommercialOctober 31, 2020

US Antibiotic Awareness Week

State & Federal

State & FederalMedicaidOctober 31, 2020

Medical drug benefit Clinical Criteria updates -- May 2020

State & FederalMedicaidOctober 31, 2020

Medical drug benefit Clinical Criteria updates -- June 2020

State & FederalMedicaidOctober 31, 2020

Prior authorization requirements for 0200T and 0201T

State & FederalMedicaidOctober 31, 2020

Prior authorization requirements for E0482

State & FederalMedicaidOctober 31, 2020

Coding spotlight: tips and best practices for compliance

State & FederalMedicaidOctober 31, 2020

New specialty pharmacy medical step therapy requirements

State & FederalMedicaidOctober 31, 2020

Digital transactions cut administrative tasks in half

State & FederalMedicaidOctober 31, 2020

Attention: updated laboratory fee schedule

State & FederalMedicaidOctober 31, 2020

Keep up with Medicaid news

State & FederalMedicare AdvantageOctober 31, 2020

Preferred continuous glucose monitors

State & FederalMedicare AdvantageOctober 31, 2020

Provider Chat -- A fast, easy way to get your questions answered

State & FederalMedicare AdvantageOctober 31, 2020

Medical drug benefit Clinical Criteria updates -- June 2020

State & FederalMedicare AdvantageOctober 31, 2020

FDA approvals and expedited pathways used -- new molecular entities

State & FederalMedicare AdvantageOctober 31, 2020

Digital transactions cut administrative tasks in half

State & FederalMedicare AdvantageOctober 31, 2020

Keep up with Medicare news