Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - December 2018

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.

 

• Medical Policy/Clinical Guidelines Updates – December 2018*

 

• Reimbursement Policy Updates – December 2018*

 

• Upcoming changes for automotive accounts (IN, KY, OH)*

 

• GM Precertification and Integrated Health Management (360 Health) changes for CY 2019*

 

• Anthem To Enhance Claim Edits for Outpatient Facility Claims*

 

• Bundled Services and Supplies: Professional*

 

• Update to AIM Clinical Appropriateness Guidelines

 

• Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

 

• Information about our Case Management and Condition Care Programs, Coordination of Care, Integrated Care Model, Utilization Management, Quality Improvement and Members Rights & Responsibilities

 

• Medicare Advantage and Medicaid Updates