Ohio
Provider Communications

July 2021 Anthem Provider News - Ohio

Download as PDF

Title Category

Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual*

*Notice of Material Amendment/Change to Contract (MAC)
Administrative

Register now to learn strategies to help you and your practice improve clinical quality

Administrative

Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims

Administrative

Proper coding for in-home monitoring can make a measurable difference for INR

Administrative

Another mark of the pandemic: An increase in childhood obesity

Administrative

How to enroll in electronic fund transfer (EFT) for faster remittance

Digital Tools

Electronic claim response files

Digital Tools

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Digital Tools

Company to retire Blue Precision program at the end of the year

Products & Programs

Reminder: Back Pain Guide program effective July 19, 2021

Products & Programs

Update: Site of care medical necessity reviews for long-acting colony-stimulating factors not implemented on June 1, 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Designated specialty pharmacy network updates effective October 1, 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Updates for specialty pharmacy are available - July 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Certain specialty medication prior authorization requests may require additional documentation*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Medical Policy and Clinical Guideline Updates - July 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Medical Policy & Clinical Guidelines

Reminder: Updated AIM rehabilitative program effective August 1, 2021 - Site of service reviews

Medical Policy & Clinical Guidelines

New reimbursement policy: Non-patient laboratory services - Facility*

*Notice of Material Amendment/Change to Contract (MAC)
Reimbursement Policies

Reimbursement policy update: Consultations - Professional*

*Notice of Material Amendment/Change to Contract (MAC)
Reimbursement Policies

Medicare News - July 2021

View these Medicare articles:
- Prior authorization requirement changes effective September 1, 2021 – UM Authorization Rule Operations Workgroup (AROW) Item 1845
- Provider notification for UM Authorization Rule Operations Workgroup (AROW) Item 1846
Medicare

Let’s Vaccinate

Medicare

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

Medicare

Medical drug benefit clinical criteria updates

Medicare

Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021

Medicare

New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing

Medicare
Page 1 of 1