Ohio
Provider Communications

Provider Spotlight

Aug 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- August 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.


Articles Recent

Title Publication Category Date

REMINDER: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019

August 2019 Anthem Provider News - Ohio Pharmacy Aug 1, 2019

Pharmacy information available at anthem.com

August 2019 Anthem Provider News - Ohio Pharmacy Aug 1, 2019

Medical Policy and Clinical Guideline Updates -- August 2019*

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Anthem customizations to MCG care guidelines 23rd edition*

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Updates to AIM Advanced Oncologic Imaging Clinical Appropriateness Guideline

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Updates to AIM Radiation Oncology: Proton Beam Therapy Clinical Appropriateness Guideline

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Reimbursement Policy Update: Bundled Services-Professional*

August 2019 Anthem Provider News - Ohio Reimbursement Policies Aug 1, 2019

Reimbursement Policy Update: Frequency Editing-Professional*

August 2019 Anthem Provider News - Ohio Reimbursement Policies Aug 1, 2019

Medicare News -- August 2019

August 2019 Anthem Provider News - Ohio Medicare Aug 1, 2019

New service types added to Availity

August 2019 Anthem Provider News - Ohio Medicare Aug 1, 2019

New Reimbursement Policy: Drug Screen Testing

August 2019 Anthem Provider News - Ohio Medicare Aug 1, 2019

AIM Specialty Health programs may require documentation

August 2019 Anthem Provider News - Ohio Medicare Aug 1, 2019

Special needs plans - provider training required

August 2019 Anthem Provider News - Ohio Medicare Aug 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- August 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
August 2019 Anthem Provider News - Ohio Administrative Aug 1, 2019

Update: Sepsis Coding

August 2019 Anthem Provider News - Ohio Administrative Aug 1, 2019

New location for Provider Manuals on anthem.com

August 2019 Anthem Provider News - Ohio Administrative Aug 1, 2019

Clinical criteria and prior authorization updates for specialty pharmacy are available*

August 2019 Anthem Provider News - Ohio Pharmacy Aug 1, 2019

UPDATE: New Rehabilitative Program remains temporarily delayed

Anthem Ohio UPDATE: New Rehabilitative Program remains temporarily delayed Products & Programs Jul 16, 2019

UPDATE: new Rehabilitative Program now effective August 1, 2019

Anthem Ohio UPDATE: new Rehabilitative Program now effective August 1, 2019 Products & Programs Jul 3, 2019

Medical Policies and Clinical Utilization Management Guidelines update -- July 2019

July 2019 Anthem Provider News - Ohio Medicare Jul 1, 2019

Sepsis diagnosis coding and billing reminder

July 2019 Anthem Provider News - Ohio Medicare Jul 1, 2019

Clinical Criteria coding updates for specialty pharmacy are available

July 2019 Anthem Provider News - Ohio Pharmacy Jul 1, 2019

Clinical criteria updates for specialty pharmacy

July 2019 Anthem Provider News - Ohio Pharmacy Jul 1, 2019

Reminder to providers: Fee schedule information

July 2019 Anthem Provider News - Ohio Administrative Jul 1, 2019

Update to Provider UM reimbursement penalties and corresponding update to Provider Manual*

July 2019 Anthem Provider News - Ohio Administrative Jul 1, 2019

Anthem Works to Simplify Payment Recovery Process for National Accounts Membership

July 2019 Anthem Provider News - Ohio Administrative Jul 1, 2019

Make the move to the Availity EDI Gateway today

July 2019 Anthem Provider News - Ohio Administrative Jul 1, 2019

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2019 Program Year Progression -- What’s in it for you and your patients?

July 2019 Anthem Provider News - Ohio Administrative Jul 1, 2019

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

July 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2019

Clinical Validation: Professional*

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

Modifier 79 reminder: Professional

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

Modifier 63 reminder: Professional

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

ICD-10-CM Coding Guidelines and Laterality: Professional

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

Anthem Federal Employee Health Benefit Program® (FEP) PPO Members will now require prior approval for specific Specialty Drugs and Site of Care

July 2019 Anthem Provider News - Ohio Federal Employee Plan (FEP) Jul 1, 2019

Outpatient Rehabilitation Program transitioning to AIM

July 2019 Anthem Provider News - Ohio Medicare Jul 1, 2019

Home health billing guidelines for contracted providers

July 2019 Anthem Provider News - Ohio Medicare Jul 1, 2019

Keep up with Medicare News -- July 2019

July 2019 Anthem Provider News - Ohio Medicare Jul 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- July 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
July 2019 Anthem Provider News - Ohio Administrative Jul 1, 2019

Anthem to acquire Beacon Health Options

N/A Behavioral Health Jun 6, 2019

Reminder and update: new Rehabilitative Program effective July 1, 2019

June 2019 Anthem Provider Newsletter - Ohio Products & Programs Jun 1, 2019

Anthem expands specialty pharmacy prior authorization list*

June 2019 Anthem Provider Newsletter - Ohio Pharmacy Jun 1, 2019

Anthem announces changes in medical non-oncology specialty drug reviews effective June 15, 2019

June 2019 Anthem Provider Newsletter - Ohio Pharmacy Jun 1, 2019

AIM programs may require additional prior authorization documentation*

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

2019 Ohio Provider Manual -- Correction

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

New ID Cards in Ohio Market

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Retrospective Program begins; benefits of direct connection access to your EMR

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

Find A Doctor -- New Sort Option

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

Coming Soon: Anthem Electronic Attachments

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

New ICR Immediate Decision List posted on Availity Payer Spaces

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

Anthem launches additional changes to anthem.com for Q2

June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

Medical Policy and Clinical Guideline Updates -- June 2019*

June 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Jun 1, 2019

New Clinical Guideline: Inpatient Inter-Facility Transfers effective September 1, 2019*

June 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Jun 1, 2019

New Reimbursement Policy: Ambulance Transportation -- Professional*

June 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies Jun 1, 2019

Reimbursement Policy Update: Frequency Editing -- Professional*

June 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies Jun 1, 2019

Keep up with Medicare News -- June 2019

June 2019 Anthem Provider Newsletter - Ohio Medicare Jun 1, 2019

Review of professional claims with emergency department level 5 E&M codes

June 2019 Anthem Provider Newsletter - Ohio Medicare Jun 1, 2019

Why do patients stop taking their prescribed medications and what can you do to help them?

June 2019 Anthem Provider Newsletter - Ohio Medicare Jun 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- June 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.
June 2019 Anthem Provider Newsletter - Ohio Administrative Jun 1, 2019

Anthem expands specialty pharmacy medical step therapy drug list for agents for hereditary angioedema*

May 2019 Anthem Provider Newsletter - Ohio Pharmacy May 1, 2019

Anthem specialty pharmacy medical step therapy drug list clarification about non-oncology colony stimulating factor agents*

May 2019 Anthem Provider Newsletter - Ohio Pharmacy May 1, 2019

Pharmacy information available at anthem.com

May 2019 Anthem Provider Newsletter - Ohio Pharmacy May 1, 2019

Electronic Member ID Cards - Easy online access on the Availity Portal

May 2019 Anthem Provider Newsletter - Ohio Administrative May 1, 2019

Review of professional claims with emergency room level 5 E/M codes

May 2019 Anthem Provider Newsletter - Ohio Administrative May 1, 2019

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Health Assessment requests for 2019 / Alternative reporting engagement

May 2019 Anthem Provider Newsletter - Ohio Administrative May 1, 2019

Anthem Contracted Ambulance Providers

May 2019 Anthem Provider Newsletter - Ohio Administrative May 1, 2019

Attention: Availity launches additional changes to the new look to our Medical Attachment submission tool

May 2019 Anthem Provider Newsletter - Ohio Administrative May 1, 2019

Clinical Guideline Update - May 2019*

May 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines May 1, 2019

MCG care guidelines 23rd Edition*

May 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines May 1, 2019

Update: Drug Screen Testing - Professional*

May 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies May 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - May 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.
May 2019 Anthem Provider Newsletter - Ohio Administrative May 1, 2019

Keep up with Medicare news - May 2019

May 2019 Anthem Provider Newsletter - Ohio Medicare May 1, 2019

The 2019 Provider Manual is now available for your review

April 2019 Anthem Provider Newsletter - Ohio Administrative Apr 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes: April 2019

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
April 2019 Anthem Provider Newsletter - Ohio Administrative Apr 1, 2019

New AIM Rehabilitative program effective July 1, 2019

April 2019 Anthem Provider Newsletter - Ohio Products & Programs Apr 1, 2019

Anthem expands specialty pharmacy prior authorization list*

April 2019 Anthem Provider Newsletter - Ohio Pharmacy Apr 1, 2019

New on Interactive Care Reviewer (ICR): Request Clinical Appeals

April 2019 Anthem Provider Newsletter - Ohio Administrative Apr 1, 2019

UM Process Change: Courtesy approval determination notifications

April 2019 Anthem Provider Newsletter - Ohio Administrative Apr 1, 2019

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Accurate coding helps provide a comprehensive picture of patients’ health and services provided

April 2019 Anthem Provider Newsletter - Ohio Administrative Apr 1, 2019

Why do patients stop taking their prescribed medications and what can you do to help them?

April 2019 Anthem Provider Newsletter - Ohio Administrative Apr 1, 2019

Medical Policy and Clinical Guidelines Updates - April 2019*

April 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Apr 1, 2019

Update to AIM Advanced Imaging of the Heart Clinical Appropriateness Guideline*

April 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Apr 1, 2019

Update to AIM Advanced Imaging of the Head and Neck Clinical Appropriateness Guidelines*

April 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Apr 1, 2019

Update to AIM Musculoskeletal Joint Surgery Clinical Appropriateness Guidelines*

April 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Apr 1, 2019

Update to AIM Sleep Disorder Management Clinical Appropriateness Guidelines*

April 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Apr 1, 2019

New Reimbursement Policy: Partial Hospitalization Program and Intensive Outpatient Program Services Facility*

April 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies Apr 1, 2019

Update regarding evaluation and management with modifier 25

April 2019 Anthem Provider Newsletter - Ohio Medicare Apr 1, 2019

Coming soon: Reimbursement for select HEDIS-related CPT II codes for Medicare Advantage members

April 2019 Anthem Provider Newsletter - Ohio Medicare Apr 1, 2019

Keep up with Medicare news - April 2019

April 2019 Anthem Provider Newsletter - Ohio Medicare Apr 1, 2019

Dual Eligible Special Needs (D-SNP) Plans - provider training required

March 2019 Anthem Provider Newsletter - Ohio Medicare Mar 1, 2019

Change to 835 ERA for all D-SNP MA members for 2019

March 2019 Anthem Provider Newsletter - Ohio Medicare Mar 1, 2019

Clinical criteria updates for specialty pharmacy

March 2019 Anthem Provider Newsletter - Ohio Medicare Mar 1, 2019

Introducing a new clinical criteria web page for injectable, infused or implanted drugs covered under the medical benefit

March 2019 Anthem Provider Newsletter - Ohio Medicare Mar 1, 2019

Keep up with Medicare news

March 2019 Anthem Provider Newsletter - Ohio Medicare Mar 1, 2019

Anthem Commercial Risk Adjustment (CRA) Program Update: Medical chart collection for ACA members due March 31, 2019

March 2019 Anthem Provider Newsletter - Ohio Administrative Mar 1, 2019

Some of your patients will begin moving to IngenioRx in Q2 2019

March 2019 Anthem Provider Newsletter - Ohio Pharmacy Mar 1, 2019

Important update to Anthem’s commercial drug lists

March 2019 Anthem Provider Newsletter - Ohio Pharmacy Mar 1, 2019

Anthem launches additional changes to anthem.com in March

March 2019 Anthem Provider Newsletter - Ohio Administrative Mar 1, 2019

Clinical criteria updates for specialty pharmacy

March 2019 Anthem Provider Newsletter - Ohio Pharmacy Mar 1, 2019

Important reminder regarding specialty pharmacy clinical site of care program

March 2019 Anthem Provider Newsletter - Ohio Pharmacy Mar 1, 2019
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