Ohio
Provider Communications

Provider Spotlight

May 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - May 2021

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.

Apr 28, 2021

Information from Anthem for Care Providers about COVID-19 (updated April 28, 2021)

We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine.


Articles Recent

Title Publication Category Date

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - May 2021

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.
May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

Specialty pharmacy prior authorization update - Certain drugs for treatment of ocular conditions continue to require prior authorization*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Pharmacy May 1, 2021

Updates for specialty pharmacy are available - May 2021*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Pharmacy May 1, 2021

Resources to support diverse patients and communities

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

2021 Affirmative statement regarding utilization management decisions

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

A helpful and complete guide to covered well-child visits

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

May is National High Blood Pressure Education Month

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

Digital online scheduling feature now available in the Availity Portal

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

Provider bulletins for medical and itemized bill attachments: Electronic solutions at your fingertips

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

Sending larger digital attachments through Availity

May 2021 Anthem Provider News - Ohio Administrative May 1, 2021

New prior authorization requirement: Kidney transplantation*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

Updated AIM rehabilitative program effective August 1, 2021 - Initial evaluations and site of service reviews*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation - Facility*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Reimbursement Policies May 1, 2021

Reimbursement policy reminder: Readmission - Facility

May 2021 Anthem Provider News - Ohio Reimbursement Policies May 1, 2021

Reimbursement policy update: Frequency editing - Professional

May 2021 Anthem Provider News - Ohio Reimbursement Policies May 1, 2021

Maximizing efficient, high quality COVID-19 screenings

May 2021 Anthem Provider News - Ohio Medicare May 1, 2021

Keep up with Medicare news - May 2021

View these Medicare articles:
- Anthem working with Optum to collect medical records for Medicare Risk Adjustment (MRA)
- Helping our senior members
- Updates to the AIM Specialty Health musculoskeletal program clinical appropriateness guidelines
May 2021 Anthem Provider News - Ohio Medicare May 1, 2021

Information from Anthem for Care Providers about COVID-19 (updated April 28, 2021)

We recently updated the effective date about reimbursement for the administration of the COVID-19 vaccine.
COVID-19 Information - Ohio Administrative Apr 28, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - April 2021

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 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

The health of millennials: Trends in behavioral health conditions

April 2021 Anthem Provider News - Ohio Behavioral Health Apr 1, 2021

Correction: Updated formulary lists for commercial health plan pharmacy benefit effective April 1, 2021

April 2021 Anthem Provider News - Ohio Pharmacy Apr 1, 2021

Updates for specialty pharmacy are available - April 2021*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Pharmacy Apr 1, 2021

Pharmacy information available at anthem.com

April 2021 Anthem Provider News - Ohio Pharmacy Apr 1, 2021

COVID fee schedule changes*

*Notice of Material Amendment/Change to Contract (MAC)
COVID-19 Information - Ohio Administrative Apr 1, 2021

Updated Provider Manual now available

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Does your practice offer telehealth services? Let us know!

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Information Center - Access important policies, forms and helpful resources

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Understanding Availity roles for electronic data interchange (EDI)

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Make the change to digital authorization/referral and hospital admission notifications using EDI

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Attention facilities: Sending admission, discharge and transfer data results in improved care management for patients

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Chat directly with a prior authorization specialist

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Keeping up with routine vaccination during COVID-19

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Interactive bilingual website taking action for our health

Exclusively developed for the Latino Community
April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Join Anthem in talking about racism and its impact on health

April 2021 Anthem Provider News - Ohio Administrative Apr 1, 2021

Medical policy and clinical guideline updates - April 2021*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

Update: Clinical guideline adoption postponed*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

MCG Care Guidelines 25th Edition available*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

Maximizing efficient, high quality COVID-19 screenings*

*Notice of Material Amendment/Change to Contract (MAC)
COVID-19 Information - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

Update for Commercial providers: AIM sleep program CPT code E1399, NOC: Durable medical equipment, miscellaneous

April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

New reimbursement policy: Newborn Inpatient Stays for facilities*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Reimbursement Policies Apr 1, 2021

HEDIS 2021 Federal Employee Program® medical record request requirements

April 2021 Anthem Provider News - Ohio Federal Employee Plan (FEP) Apr 1, 2021

Does your practice offer telehealth services? Let us know!

April 2021 Anthem Provider News - Ohio Medicare Apr 1, 2021

In-Office Assessment program

April 2021 Anthem Provider News - Ohio Medicare Apr 1, 2021

Oncology dose reduction program beginning July 1, 2021

April 2021 Anthem Provider News - Ohio Medicare Apr 1, 2021

Clinical criteria updates notification - November 2020

April 2021 Anthem Provider News - Ohio Medicare Apr 1, 2021

Clinical criteria updates notification - December 2020

April 2021 Anthem Provider News - Ohio Medicare Apr 1, 2021

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021*

*Material Adverse Change (MAC)
March 2021 Anthem Provider News - Ohio Pharmacy Mar 1, 2021

Updates for specialty pharmacy are available - March 2021*

*Material Adverse Change (MAC)
March 2021 Anthem Provider News - Ohio Pharmacy Mar 1, 2021

Some HIV medication combinations may require prior authorization

March 2021 Anthem Provider News - Ohio Pharmacy Mar 1, 2021

Medical attachment capability now includes itemized bills and more!

March 2021 Anthem Provider News - Ohio Administrative Mar 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery guideline

March 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Mar 1, 2021

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

March 2021 Anthem Provider News - Ohio Reimbursement Policies Mar 1, 2021

Medicare News - March 2021

View these Medicare articles:
- MCG Care Guidelines 24th edition customization
- DME checklist of information needed from providers
March 2021 Anthem Provider News - Ohio Medicare Mar 1, 2021

New provider directory indicator for telehealth services

March 2021 Anthem Provider News - Ohio Medicare Mar 1, 2021

Medical policies and clinical utilization management guidelines update

March 2021 Anthem Provider News - Ohio Medicare Mar 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - March 2021

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.
March 2021 Anthem Provider News - Ohio Administrative Mar 1, 2021

Anthem clarifies guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)*

*Material Adverse Change (MAC)
March 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Mar 1, 2021

Access to more claim denial information is now self-service

March 2021 Anthem Provider News - Ohio Medicare Mar 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - February 2021

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.
February 2021 Anthem Provider News - Ohio Administrative Feb 1, 2021

Anthem to update formulary lists for commercial health plan pharmacy benefit

February 2021 Anthem Provider News - Ohio Pharmacy Feb 1, 2021

Designated specialty pharmacy network*

February 2021 Anthem Provider News - Ohio Pharmacy Feb 1, 2021

Prior authorization updates for specialty pharmacy are available - February 2021*

February 2021 Anthem Provider News - Ohio Pharmacy Feb 1, 2021

Pharmacy information available at anthem.com

February 2021 Anthem Provider News - Ohio Pharmacy Feb 1, 2021

New provider directory indicator for telehealth services

February 2021 Anthem Provider News - Ohio Administrative Feb 1, 2021

New Anthem utilization management tool now available on Availity: Authorization Rules Lookup tool

February 2021 Anthem Provider News - Ohio Administrative Feb 1, 2021

Medical Policy and Clinical Guideline Updates - February 2021*

February 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2021

Reimbursement policy update: Emergency Room Transfers - Facility*

February 2021 Anthem Provider News - Ohio Reimbursement Policies Feb 1, 2021

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility*

February 2021 Anthem Provider News - Ohio Reimbursement Policies Feb 1, 2021

PN for UM AROW Item 1330

February 2021 Anthem Provider News - Ohio Medicare Feb 1, 2021

Medical drug benefit clinical criteria updates - February 2021

February 2021 Anthem Provider News - Ohio Medicare Feb 1, 2021

Register today for The Road to Allyship Forum hosted by Anthem and Motivo on February 3, 2021

Join us to hear from a diverse panel of experienced Motivo and Anthem professionals about racial equity and the importance of allies.
The Road to Allyship Forum Invitation Administrative Jan 21, 2021

Important COVID-19 update: Prior authorization and other policy adjustments (Updated January 13, 2021)

Prior authorization requirements updated for patient transfers from acute inpatient hospitals to skilled nursing facilities.
COVID-19 Information - Ohio Administrative Jan 13, 2021

COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services (Updated January 8, 2021)

We’ve updated information about coverage for telephonic-only care.
COVID-19 Information - Ohio Administrative Jan 8, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - January 2021

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.
January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

IngenioRx introduces new pharmacy network in 2021

January 2021 Anthem Provider News - Ohio Pharmacy Jan 1, 2021

Prior authorization updates for specialty pharmacy are available - January 2021*

January 2021 Anthem Provider News - Ohio Pharmacy Jan 1, 2021

It is almost CAHPS survey time!

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Evaluation and management changes 2021

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

New Blue HPN® plans go live January 1, 2021

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Outpatient system updates for 2021 - Facility

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Professional system updates for 2021

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

New features added to Interactive Care Reviewer

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Procedure searches in Find Care: New sort option

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Availity attachment tools for Anthem and affiliate payers - Live webinars

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Self-service, digital transactions are fast and easy

January 2021 Anthem Provider News - Ohio Administrative Jan 1, 2021

Medical Policy and Clinical Guideline Updates - January 2021*

January 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2021

MCG Care Guidelines 24th Edition Customization*

January 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2021

Anthem implements pilot program for in-network skilled nursing facilities (SNF)

January 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2021

Reimbursement policy update: Multiple diagnostic imaging procedures - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Frequency editing - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Guidelines for reporting timed units for physical medicine and rehabilitation - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Modifier Rules - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Unit frequency maximum for drugs and biologicals - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

2021 FEP® benefit information available online

January 2021 Anthem Provider News - Ohio Federal Employee Plan (FEP) Jan 1, 2021

Keep up with Medicare news - January 2021

View these Medicare articles:
- Medicare Advantage Group Retiree Quick Reference Guide and FAQ
- Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ
- SNF admission reporting requirements for D-SNP plans
- Policy Update: Nurse Practitioner and Physician Assistant Services – Professional
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
January 2021 Anthem Provider News - Ohio Medicare Jan 1, 2021

2020 Medicare risk adjustment provider trainings

January 2021 Anthem Provider News - Ohio Medicare Jan 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

January 2021 Anthem Provider News - Ohio Medicare Jan 1, 2021
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