Ohio
Provider Communications

December 2018 Anthem Ohio Provider Newsletter

Download as PDF

Title	Category
Upcoming Changes for Automotive Accounts	Products & Programs
GM Precertification and Integrated Health Management (360 Health) changes for CY 2019	Products & Programs
Anthem Accepts Electronic Prior Authorization Requests for Prescription Medications Online	Pharmacy
Introducing the New Clinical Criteria Page for Injectable, Infused or Implanted Drugs	Pharmacy
Anthem Streamlines Member ID Cards - Use Availity to Verify Members' Cost Shares and Benefits at Time of Service	Administrative
Availity to Serve as EDI Entry Point for Electronic Submissions	Administrative
Anthem Works to Simplify Payment Recovery Process for National Accounts Membership	Administrative
HEDIS® 2018 Commercial Results Are In	Administrative
Case Management Program	Administrative
ConditionCare Program Benefits Patients and Physicians	Administrative
Integrated Care Model for Plans Purchased on the Health Insurance Marketplace Benefits Patients and Physicians	Administrative
Coordination of Care	Administrative
Important Information about Utilization Management	Administrative
Members’ Rights and Responsibilities	Administrative
Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web	Administrative
Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines	Coverage and Clinical Guidelines
Update to AIM Clinical Appropriateness Guidelines	Coverage and Clinical Guidelines
Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines	Coverage and Clinical Guidelines
Interactive Care Reviewer (ICR) New Features	Coverage and Clinical Guidelines
Bundled Services and Supplies (Professional)	Reimbursement Policies
Reimbursement for Convenience Surgical Supply Kits: Professional	Reimbursement Policies
Medical Polices and Clinical Guidelines Updates - December 2018	Medical Policy & Clinical Guidelines
View reimbursement policies online at anthem.com	Reimbursement Policies
Reimbursement Policy Updates - December 2018	Reimbursement Policies
Reimbursement Policy Update - Scope of License (Professional)	Reimbursement Policies
2019 FEP Benefit information available online	Federal Employee Plan (FEP)
Coordination of Benefits for an FEP® member	Federal Employee Plan (FEP)
Benefit change for Infliximab for Federal Employee Program (FEP)	Federal Employee Plan (FEP)
New Medicare Advantage provider service phone number beginning January 1, 2019	Medicare
2019 Medicare Advantage individual benefits and formularies	Medicare
CMS Medicare Preclusion List effective April 1, 2019	Medicare
When and how to initiate Medicare Advantage reopenings	Medicare
Individual Medicare plans move compound drugs off formulary beginning January 1, 2019	Medicare
Medicare Part B drugs may include Step Therapy beginning January 1, 2019	Medicare
Anthem MA Ohio Field Based Case Management Program	Medicare
Members with COPD eligible for health improvement program	Medicare
Keep up with Medicare news	Medicare
Anthem to Enhance Claim Edits for Outpatient Facility Claims	Administrative
Pharmacy Information Available at anthem.com	Pharmacy
Members Can Shop for Cost-Efficient Health Care Using SmartShopper	Administrative
Clinical practice and preventive health guidelines available on anthem.com	Medical Policy & Clinical Guidelines
Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - December 2018 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.	Administrative

Page 1 of 1

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.