Ohio
Provider Communications

Provider Spotlight

Nov 25, 2020

Important COVID-19 update: Prior authorization and other policy adjustments (Updated November 25, 2020)

We’ve updated guidance about prior authorization requirements.

Nov 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - November 2020

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.

Nov 1, 2020

Availity attachment tools for Anthem and affiliate payers - Live Webinars

Sign up for upcoming webinars!


Articles Recent

Title Publication Category Date

Important COVID-19 update: Prior authorization and other policy adjustments (Updated November 25, 2020)

We’ve updated guidance about prior authorization requirements.
COVID-19 Information - Ohio Administrative Nov 25, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - November 2020

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.
November 2020 Anthem Provider News - Ohio Administrative Nov 1, 2020

IngenioRx Introduces new pharmacy network in 2021

November 2020 Anthem Provider News - Ohio Pharmacy Nov 1, 2020

Prior authorization updates for specialty pharmacy are available - November 2020*

November 2020 Anthem Provider News - Ohio Pharmacy Nov 1, 2020

Availity attachment tools for Anthem and affiliate payers - Live Webinars

Sign up for upcoming webinars!
November 2020 Anthem Provider News - Ohio Administrative Nov 1, 2020

Clinical Laboratory Improvement Amendments (CLIA) Number - Additional Information

November 2020 Anthem Provider News - Ohio Administrative Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Ohio Administrative Nov 1, 2020

Get the full picture of your patient’s health through their smartphone

November 2020 Anthem Provider News - Ohio Administrative Nov 1, 2020

US Antibiotic Awareness Week

November 2020 Anthem Provider News - Ohio Administrative Nov 1, 2020

Medical policy and clinical guideline updates - November 2020*

November 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2020

Correction to Prior Authorization Update for Commercial business*

November 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2020

Reminder: Post-service reviews using AIM

November 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2020

New reimbursement policy: Documentation standards for episodes of care (Professional)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Modifier rules (Professional)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Multiple diagnostic imaging facility (Facility)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Medicare News - November 2020

View these Medicare articles:
- AIM rehabilitation prior authorizations suspended for Group Retiree Solutions members until December 31, 2020
- Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines
- AIM Musculoskeletal program expansion postponed
November 2020 Anthem Provider News - Ohio Medicare Nov 1, 2020

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

November 2020 Anthem Provider News - Ohio Medicare Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Ohio Medicare Nov 1, 2020

FDA approvals and expedited pathways used - new molecular entities

November 2020 Anthem Provider News - Ohio Medicare Nov 1, 2020

Register today for a Racial Trauma Forum hosted by Anthem and Motivo on October 28, 2020

Racial Trauma Forum invitation - Ohio Behavioral Health Oct 14, 2020

Information from Anthem for Care Providers about COVID-19 (Updated October 9, 2020)

We recently updated FAQs about COVID-19 testing and visits associated with COVID-19 testing.
COVID-19 Information - Ohio Administrative Oct 9, 2020

Anthem updates formulary lists for commercial health plan pharmacy benefit

October 2020 Anthem Provider News - Ohio Pharmacy Oct 1, 2020

Prior authorization updates for specialty pharmacy are available - October 2020*

October 2020 Anthem Provider News - Ohio Pharmacy Oct 1, 2020

Updated coverage for breast cancer prevention medications

October 2020 Anthem Provider News - Ohio Pharmacy Oct 1, 2020

FDA approvals and expedited pathways used - New Molecular Entities (NMEs)

October 2020 Anthem Provider News - Ohio Pharmacy Oct 1, 2020

Pharmacy information available at anthem.com

October 2020 Anthem Provider News - Ohio Pharmacy Oct 1, 2020

National Accounts 2021 Pre-certification list*

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

Anthem Chat: A fast, easy way to have your questions answered

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

New medical claim attachment webinars: Register today

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

Electronic member ID cards available on the Availity portal

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

What Matters Most: Improving the patient experience

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

Anthem Commercial Risk Adjustment (CRA) Reporting Update: New guidance on telephone-only service CPT codes for risk adjustment program

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

Medical policy and clinical guideline updates - October 2020*

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Prior authorization update for Commercial Individual Business*

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Transition to AIM rehabilitative service clinical appropriateness guidelines

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Reminder: Expansion of AIM Musculoskeletal Program effective November 1, 2020

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Reimbursement policy update: Emergency department - leveling of Evaluation and Management services (Facility)*

October 2020 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Claims requiring additional documentation policy (Facility)

October 2020 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Laboratory and venipuncture (Professional)*

October 2020 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2020

Federal Employee Program® expands specialty pharmacy prior authorization list*

October 2020 Anthem Provider News - Ohio Federal Employee Plan (FEP) Oct 1, 2020

Medicare News - October 2020

View these Medicare articles:
- Evaluation and management services correct coding
- Medical policies and clinical utilization management guidelines update
- Prior authorization requirements for the below codes effective January 2021
October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Medical drug benefit clinical criteria updates

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Prior authorization requirements for the below codes effective January 1, 2021

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Social determinants of health support expanding with GroundGame Health

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Provider transparency update

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - October 2020

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.
October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

New Blue HPN® network included in plans available for employee open enrollment Fall 2020

October 2020 Anthem Provider News - Ohio Products & Programs Oct 1, 2020

Updated Provider Manual now available*

October 2020 Anthem Provider News - Ohio Administrative Oct 1, 2020

Patient360 enhancement for medical providers

October 2020 Anthem Provider News - Ohio Medicare Oct 1, 2020

COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services (Updated September 29, 2020)

We are extending cost share waivers for telehealth and telephonic-only care. 
COVID-19 Information - Ohio Administrative Sep 29, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - September 2020

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.
September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Inclusion of AIM-reviewed services in UM reimbursement penalties

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020*

September 2020 Anthem Provider News - Ohio Products & Programs Sep 1, 2020

Meet your Cancer Care Navigator

Anthem’s new cancer support program helps improve outcomes while easing burdens for you and your patients.
September 2020 Anthem Provider News - Ohio Products & Programs Sep 1, 2020

Predictive analytics guide proactive support to patients undergoing chemotherapy resulting in lowered admissions

September 2020 Anthem Provider News - Ohio Products & Programs Sep 1, 2020

Anthem to update formulary lists for commercial health plan pharmacy benefit

September 2020 Anthem Provider News - Ohio Pharmacy Sep 1, 2020

Specialty pharmacy updates are available - September 2020*

September 2020 Anthem Provider News - Ohio Pharmacy Sep 1, 2020

New provider directory indicators for medication assisted treatment (MAT) providers

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

EDI Gateway migration deadline is September 15, 2020

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Providers can now receive and respond to medical record requests for post-pay audit via Change Healthcare’s Assurance Attach Assist Module

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Enhanced medical records submission process to support claims processing

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Patient360 adds care gap alert feedback for medical providers

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Prospective Program continues

September 2020 Anthem Provider News - Ohio Administrative Sep 1, 2020

Reimbursement policy update: Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)*

September 2020 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2020

Reimbursement policy update: Frequency Editing (Professional)*

September 2020 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2020

Update: Notice of changes to the AIM musculoskeletal program

September 2020 Anthem Provider News - Ohio Medicare Sep 1, 2020

Medical drug benefit clinical criteria updates

September 2020 Anthem Provider News - Ohio Medicare Sep 1, 2020

Notice of material changes/amendments to contract and prior authorization changes - August 2020

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.
- Anthem prior authorization updates for specialty pharmacy are available-August 2020*
- Medical Policy and Clinical Guideline Updates-August 2020*
- Expansion of AIM Musculoskeletal Program effective November 1, 2020*
- Reimbursement Policy Update: Claims requiring additional documentation (Facility)*
August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Anthem to update formulary lists for commercial health plan pharmacy benefit

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

Voluntary site of care outreach for oncology checkpoint inhibitors beginning August 1, 2020

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

Anthem prior authorization updates for specialty pharmacy are available - August 2020*

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

Pharmacy information available on anthem.com

August 2020 Anthem Provider News - Ohio Pharmacy Aug 1, 2020

Provider contract and fee schedule notifications coming soon

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Resources to support diverse patients and communities

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Evaluation and management services correct coding (Professional)

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Migrate your EDI transactions to Availity today

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Electronic claims submission - Clinical Laboratory Improvement Amendments (CLIA)

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Anthem electronic attachments - X12 275 5010

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Coming soon: Enhance your prior authorization and inpatient admission and discharge notification via electronic and digital self-service for 2020

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Medical record standards

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Appropriate coding helps provide a comprehensive picture of patients’ health

August 2020 Anthem Provider News - Ohio Administrative Aug 1, 2020

Medical policy and clinical guideline updates - August 2020*

August 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2020

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

August 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2020

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

August 2020 Anthem Provider News - Ohio Reimbursement Policies Aug 1, 2020

Medicare News - August 2020

View these Medicare articles:
- Submit behavioral health authorizations via our online Interactive Care Reviewer (ICR) tool
- Updates to AIM musculoskeletal program clinical appropriateness guidelines
- Provider data update
- Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM
- AIM Musculoskeletal program expansion
- New MCG Care Guidelines 24th edition
August 2020 Anthem Provider News - Ohio Medicare Aug 1, 2020

Medical drug benefit clinical criteria updates

August 2020 Anthem Provider News - Ohio Medicare Aug 1, 2020

2020 Medicare risk adjustment provider trainings

August 2020 Anthem Provider News - Ohio Medicare Aug 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - July 2020

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 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

Update: New go-live date for level of care medical necessity review of upper and lower endoscopy procedures

July 2020 Anthem Provider News - Ohio Products & Programs Jul 1, 2020

Updated coverage for HIV PrEP medications

July 2020 Anthem Provider News - Ohio Pharmacy Jul 1, 2020

Anthem prior authorization updates for specialty pharmacy are available - July 2020*

July 2020 Anthem Provider News - Ohio Pharmacy Jul 1, 2020

Important change to prior authorization requests for inpatient hospital admissions*

July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

Welcome to the Custom Learning Center in Availity

July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Program Year Progression - What’s in it for you and your patients?

July 2020 Anthem Provider News - Ohio Administrative Jul 1, 2020

New MCG 24th Edition Guidelines

July 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2020

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations*

July 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2020

Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members

July 2020 Anthem Provider News - Ohio Federal Employee Plan (FEP) Jul 1, 2020

Medicare News - July 2020

View these Medicare articles:
- New behavioral health discharge call-in line
- Medical policies and clinical utilization management guidelines update
- Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines
- Transition to AIM rehabilitative services clinical appropriateness guidelines
- Modifier use reminders
July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020

Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

July 2020 Anthem Provider News - Ohio Medicare Jul 1, 2020
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